title: Routine postoperative upper gastrointestinal series after Roux-en-Y gastric bypass: determination of whether it is necessary.
abstract: OBJECTIVE
  To evaluate the clinical utility of the routine use of postoperative barium swallow to diagnose postoperative complications in patients undergoing open or laparoscopic Roux-en-Y gastric bypass.
  
  
  METHODS
  A total of 417 consecutive patients undergoing Roux-en-Y gastric bypass at our institution between January 1, 2001, and December 31, 2002, were included. We performed 341 open procedures and 76 laparoscopic gastric bypasses. All patients received a limited postoperative fluoroscopic upper gastrointestinal series, except for the patients who exceeded the weight limitation of the radiologic equipment. Radiologic findings of anastomotic complications were anastomotic leak, delayed gastric emptying, gastric outlet obstruction, and gastrogastric fistula. We evaluated clinical signs and symptoms to obtain a list of criteria suggesting these complications. Patients were stratified into 2 groups: those with and those without radiographic anastomotic complications. Clinical and radiologic criteria were compared using univariate and multivariate logistic regression analysis.
  
  
  RESULTS
  We noted 42 radiologic abnormalities during a routine postoperative barium swallow evaluation. Among our 417 patients, we documented 12 leaks (2.9%), 19 cases of delayed gastric emptying (4.6%), 4 gastric outlet obstructions (1.0%), and 7 gastrogastric fistulas (1.7%). The combination of fever, tachycardia, and tachypnea was the most specific indicator of a leak, at 0.99 (95% confidence limit, 0.99, 1.01). Nausea with vomiting was the most predictive indicator of delayed gastric emptying and gastric outlet obstruction, with a specificity of 0.99 (95% confidence limit, 0.98, 0.99) and 0.97 (95% confidence limit, 0.96, 0.99), respectively.
  
  
  CONCLUSIONS
  Postoperative complications after Roux-en-Y gastric bypass surgery are predictable based on the patient's symptoms. The use of routine postoperative fluoroscopic upper gastrointestinal series is unnecessary in asymptomatic patients.
authors.affiliation: Department of Surgery, Pennsylvania Hospital, 301 S Eighth St, Floor 4, Philadelphia, PA 19106-4000, USA. Skolakowskijr@yahoo.com
authors.forename: Stephen
authors.initials: S
authors.lastname: Kolakowski
authors.forename: Matt L
authors.initials: ML
authors.lastname: Kirkland
authors.forename: Alan L
authors.initials: AL
authors.lastname: Schuricht
mesh_terms: D000284:Administration, Oral; D003287:Contrast Media / Q000008:administration & dosage; D003955:Diagnostic Tests, Routine; D003974:Diatrizoate Meglumine / Q000008:administration & dosage; D005260:Female; D005471:Fluoroscopy; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008297:Male; D020380:Needs Assessment; D009765:Obesity / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine