title: Mucosal tonometry as early warning of gastrojejunal leak in laparoscopic Roux-en-y gastric bypass.
abstract: The laparoscopic Roux-en-Y gastric bypass (LRYGB) is the standard surgical procedure for morbidly obese patients in many centers worldwide. The gastrojejunal anastomosis (GJA) leak has a 2 % incidence and a 10 % mortality. This prospective study aims to test gastroenteric tonometry as an early warning of GJA leak risk. A nasogastric tube with tonometric capability was used to monitor gastroenteric mucosal carbon dioxide partial pressure (PgeCO2) in 32 consecutive patients during the first 24 to 72 postoperative hours after LRYGB. Sensitivity was 100 %, specificity 96.77 %, likelihood ratio 31, and area under receiver operating characteristic curve 0.984. The only early gastrojejunal leak occurred to the patient with maximal PgeCO2 (13.9 kPa) of the cohort. The remaining patients kept a PgeCO2 below 11 kPa except one; none of these developed early GJA leak. Mucosal gastroenteric tonometry may be a useful predictor of early GJA leak of the LRYGB.
authors.affiliation: Anesthesiology, Hospital General Universitario de Ciudad Real, 13005 Ciudad Real, Spain. pascrib@hotmail.com
authors.forename: Javier
authors.initials: J
authors.lastname: Pascual-Ramírez
authors.forename: Luis G
authors.initials: LG
authors.lastname: Collar Viñuelas
authors.forename: Jesús
authors.initials: J
authors.lastname: Martín
authors.forename: Ginés
authors.initials: G
authors.lastname: Bernal
authors.forename: Alfredo
authors.initials: A
authors.lastname: Bosque Castro
authors.forename: Nieves
authors.initials: N
authors.lastname: García-Serrano
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000209:etiology; D042241:Early Diagnosis; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000503:physiopathology; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008365:Manometry / Q000379:methods; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013270:Stomach / Q000601:surgery*