Utility of routine versus selective upper gastrointestinal series to detect anastomotic leaks after laparoscopic gastric bypass.
BACKGROUND
In up to 4% of laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures, anastomotic leaks occur. Early detection of gastrointestinal leakage is important for successful treatment. Consequently, many centers advocate routine postoperative upper gastrointestinal (UGI) series. The aim of this study was to determine the utility of this practice after LRYGB.


METHODS
Eight hundred four consecutive patients undergoing LRYGB from June 2000 to April 2010 were analyzed prospectively. The first 382 patients received routine UGI series between the third and fifth postoperative days (group A). Thereafter, the test was only performed when clinical findings (tachycardia, fever, and drainage content) were suspicious for a leak of the gastrointestinal anastomosis (group B; n = 422).


RESULTS
Overall, nine of 804 (1.1%) patients suffered from leaks at the gastroenterostomy. In group A, four of 382 (1%) patients had a leak, but only two were detected by the routine UGI series. This corresponds to a sensitivity of 50%. In group B, the sensitivity was higher with 80%. Specificities were comparable with 97% and 91%, respectively. Routine UGI series cost only 1.6% of the overall costs of a non-complicated gastric bypass procedure. With this leak rate and sensitivity, US $86,800 would have to be spent on 200 routine UGI series to find one leak which is not justified.


CONCLUSIONS
This study shows that routine UGI series have a low sensitivity for the detection of anastomotic leaks after LRYGB. In most cases, the diagnosis is initiated by clinical findings. Therefore, routine upper gastrointestinal series are of limited value for the diagnosis of a leak.
Schiesser
Marc
M
Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland.
Guber
Josef
J
Wildi
Stefan
S
Guber
Ivo
I
Weber
Markus
M
Muller
Markus K
MK
D000328:Adult; D057868:Anastomotic Leak / Q000000981:diagnostic imaging* / Q000191:economics / Q000453:epidemiology; D003287:Contrast Media / Q000008:administration & dosage; D003365:Costs and Cost Analysis; D003974:Diatrizoate Meglumine / Q000008:administration & dosage; D005260:Female; D005471:Fluoroscopy / Q000191:economics; D015390:Gastric Bypass; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013557:Switzerland; D041742:Upper Gastrointestinal Tract / Q000000981:diagnostic imaging*
D003287:Contrast Media; D003974:Diatrizoate Meglumine