title: Orogastric tube complications in laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Recent national efforts have focused on improving patient safety in surgical procedures including examining adverse events. An adverse event in laparoscopic Roux-en-Y gastric bypass (LRYGBP) which has not received much scrutiny involves orogastric tube complications during gastric pouch formation.
  
  
  METHODS
  Retrospective review was conducted of all LRYGBPs (n=727) performed by 5 surgeons over 5 years at 2 institutions. Cases with intraoperative orogastric tube (OGT) related complications (n=9) were identified.
  
  
  RESULTS
  9 patients (1.2%) had preventable orogastric tube-related complications. Mean patient demographics were as follows: age 47 years, female 56%, pre-op BMI 52 kg/m(2), co-morbidities 3.5 and mortality 0%. 7 of 9 patients' cases were complicated by stapling of an orogastric tube during gastric pouch formation. The remaining 2 patients had complications involving suturing of the Levacuator tube during gastrojejunostomy formation. All complications required gastric pouch or anastomotic revision. 2 patients required conversion to an open procedure, 2 required re-operation for anastomotic leak, and 1 had respiratory failure and prolonged hospital stay.
  
  
  CONCLUSIONS
  Orogastric tube complications can occur during laparoscopic RYGBP, but are seldom reported and can be associated with significant morbidity. Treatment options are dependent upon the situation. More importantly, prevention strategies must include constant communication with the anesthesiologist and removal or manipulation of an OGT prior to stapling or suturing, use of large bore OGTs for increased visual or tactile recognition, retraction of the OGT proximal to the anastomosis during gastrojejunal construction and employing alternatives to esophageal temperature probes (i.e. Foley temperature probes).
authors.affiliation: Dept. of Surgery, University Medical Center, Stanford School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
authors.forename: Barry S
authors.initials: BS
authors.lastname: Sanchez
authors.forename: Bassem Y
authors.initials: BY
authors.lastname: Safadi
authors.forename: Jennefer A
authors.initials: JA
authors.lastname: Kieran
authors.forename: Gloria P
authors.initials: GP
authors.lastname: Hsu
authors.forename: Jay B
authors.initials: JB
authors.lastname: Brodsky
authors.forename: Myriam J
authors.initials: MJ
authors.lastname: Curet
authors.forename: John M
authors.initials: JM
authors.lastname: Morton
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control / Q000601:surgery; D007441:Intubation, Gastrointestinal / Q000009:adverse effects* / Q000295:instrumentation; D020706:Laparoscopes; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D012189:Retrospective Studies