title: Is routine postoperative gastrografin study needed after laparoscopic sleeve gastrectomy? Experience of 712 cases.
abstract: BACKGROUND
  The current standard of care is to perform a postoperative gastrografin study following laparoscopic sleeve gastrectomy (LSG) to detect leakage or obstruction. This study evaluated the usefulness of this routine procedure.
  
  
  METHODS
  A retrospective chart review was performed in December 2012. All patients had routine intraoperative methylene blue testing to check for possible leakage from the staple line, and any leaking points were oversewn. We also performed postoperative contrast study (gastrografin) routinely in the first 24-48 h for all patients.
  
  
  RESULTS
  From June 2007 to December 2012, 712 cases underwent LSG during the study period. Patients included in this study were 556 women (78.1%) and 156 men (21.9%). The mean age was 35 years. The mean BMI was 48 kg/m2. The operative time was 107 ± 29 min, and there were no conversions to open surgery. Intraoperative methylene blue test detected leakage in 28 cases (3.93%). Postoperative contrast study (gastrografin) was negative for leakage in all cases. Computed tomography (CT) scan with oral contrast study detected leakage in 1.4% (ten cases); none of these cases were detected by regular contrast study.
  
  
  CONCLUSIONS
  Our study showed that intraoperative methylene blue test for leakage is a very sensitive and effective method for detecting leakage during sleeve gastrectomy and should be done routinely in all cases. Routine postoperative contrast study is not needed to detect leakage unless clinically indicated in selected cases, and in such cases contrast-enhanced CT scans are the modality of choice.
authors.affiliation: Department of Surgery, Jahra Hospital, Kuwait, Kuwait.
authors.forename: M
authors.initials: M
authors.lastname: Wahby
authors.forename: A F
authors.initials: AF
authors.lastname: Salama
authors.forename: A F
authors.initials: AF
authors.lastname: Elezaby
authors.forename: F
authors.initials: F
authors.lastname: Belgrami
authors.forename: M E
authors.initials: ME
authors.lastname: Abd Ellatif
authors.forename: H F
authors.initials: HF
authors.lastname: El-Kaffas
authors.forename: M
authors.initials: M
authors.lastname: Al-Katary
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000191:economics / Q000209:etiology; D015992:Body Mass Index; D003287:Contrast Media; D003362:Cost-Benefit Analysis; D003974:Diatrizoate Meglumine; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000191:economics; D015390:Gastric Bypass / Q000009:adverse effects* / Q000191:economics; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000191:economics; D008297:Male; D008499:Medical Records; D008751:Methylene Blue; D009767:Obesity, Morbid / Q000150:complications / Q000191:economics / Q000601:surgery*; D061646:Operative Time; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D019564:Unnecessary Procedures / Q000191:economics
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine; D008751:Methylene Blue