title: Role of intraoperative esophagogastroenteroscopy in minimizing gastrojejunostomy-related morbidity: experience with 2,311 laparoscopic gastric bypasses with linear stapler anastomosis.
abstract: BACKGROUND
  Anastomotic leaks and strictures of the gastrojejunostomy are a cause of major morbidity following laparoscopic Roux-en-Y gastric bypass (LRYGB). Reported rates of leaks vary between 0 and 5.2%. This has led bariatric surgeons to use a variety of intraoperative methods to detect incompetent suture lines. The aim of the study was to evaluate the role of intraoperative endoscopy in reducing the rate of postoperative anastomotic complications. The setting of this study is in a community teaching hospital.
  
  
  METHODS
  Medical records of 2,311 patients who underwent a LRYGB from 2002 to 2011 were retrospectively reviewed utilizing the hospitals' bariatric surgery database. Demographics, weight, body mass index, intraoperative endoscopy results, and postoperative outcomes within 90 days after surgery were analyzed.
  
  
  RESULTS
  Endoscopy was attempted in 2,311 patients and completed in 2,308 (99.9%). Intraoperative leak was detected in 80 (3.5%) patients; suture line was reinforced in 46 patients (2%), while in the other 34 patients the leak was transient at only high insufflation pressure. Postoperative clinical leaks were detected in four cases (0.2%) two of which had initial leaks intraoperatively. In two cases, the anastomosis was too tight and required reconstruction. Twenty-five patients (1.1%) developed early postoperative strictures requiring endoscopic dilatation within 90 days. Three patients (0.1%) had iatrogenic injury at the time of intraoperative endoscopy, all three healed without delayed morbidity.
  
  
  CONCLUSIONS
  The routine use of intraoperative endoscopy in LRYGB with the linear stapler anastomosis technique is associated with a complication/failure rate of 0.3% and low gastrojejunostomy-related morbidity after LRYGB within 90 days (leak rate of 0.2% and stricture rate of 1.1%).
authors.affiliation: Saint Agnes Hospital, Baltimore, MD, USA.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Haddad
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tapazoglou
authors.forename: Kuldeep
authors.initials: K
authors.lastname: Singh
authors.forename: Andrew
authors.initials: A
authors.lastname: Averbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects*; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009017:Morbidity; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013528:Surgical Staplers; D013536:Suture Techniques; D016896:Treatment Outcome