title: Back to basics--clinical diagnosis in bariatric surgery. Routine drains and upper GI series are unnecessary.
abstract: BACKGROUND
  The routine use of closed suction drains and upper GI (UGI) series has been used to aid in the diagnosis and management of gastrojejunal leak after gastric bypass as well as diagnose intra-abdominal bleeding.
  
  
  METHODS
  352 consecutive laparoscopic gastric bypass procedures were performed without the use of routine drains or post-operative UGI series.
  
  
  RESULTS
  There were no adverse events related the lack of routine drains or UGI studies. Five patients (1.4%) did have a drain placed at the time of surgery, at the surgeon's discretion, due to a particularly difficult gastrojejunal anastomosis although none developed an anastomotic leak. UGI series were ordered post-operatively in seven patients all for unexplained tachycardia, none of who had abnormal radiographic findings. Two patients with tachycardia and normal UGIs had a negative diagnostic laparoscopy to rule out a leak. No UGI series demonstrated a leak although one tachycardic patient with a normal UGI did have a leak diagnosed at laparoscopy. Five patients had clinical signs of a severe gastrojejunal obstruction. Three resolved completely within 48 hours, and two patients required endoscopic intervention without the need for UGI. Six patients (1.7%) required a blood transfusion; all developed tachycardia and five were from bleeding in the GI tract.
  
  
  CONCLUSIONS
  Routine use of drains and UGI series were not necessary for the safe management of gastric bypass patient in our series. In this small series, clinical indicators for leak, obstruction or bleeding were obvious without the additional data from a drain or UGI.
authors.affiliation: Albert Einstein Healthcare Network, Philadelphia, PA, USA. dallalr@einstein.edu
authors.forename: Ramsey M
authors.initials: RM
authors.lastname: Dallal
authors.forename: Linda
authors.initials: L
authors.lastname: Bailey
authors.forename: Nissin
authors.initials: N
authors.lastname: Nahmias
mesh_terms: D001803:Blood Transfusion; D016145:Endoscopy, Digestive System; D015390:Gastric Bypass / Q000009:adverse effects*; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis*; D011859:Radiography; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013396:Suction; D013610:Tachycardia / Q000209:etiology; D019564:Unnecessary Procedures; D041742:Upper Gastrointestinal Tract / Q000000981:diagnostic imaging