title: The utility of routine postoperative upper gastrointestinal swallow studies following laparoscopic sleeve gastrectomy.
abstract: Laparoscopic sleeve gastrectomy (LSG) has grown in popularity in recent years for the treatment of morbid obesity. Controversy exists regarding the usefulness of upper gastrointestinal (UGI) swallow studies on the first postoperative day in detecting possible complications. The aim of our study was to determine the efficacy and cost benefit of routine UGI studies on the first postoperative day following LSG. We retrospectively reviewed the hospital's records to identify patients who underwent LSG between January 2012 and June 2013. All patients had iodine-based contrast swallow study on the first postoperative day. Reports from all imaging studies and medical files were retrospectively reviewed, and complications were recorded. The Institutional Review Board waived the requirement for informed consent. During the study period, 722 patients underwent LSG. Mean BMI was 43 kg/m(2) (range 25-70). Of the 722 UGI studies, 721 were normal. The 1 abnormal study showed complete obstruction due to an incarcerated hiatal hernia. Five patients presented with a leak (0.7%). UGI swallow studies failed to detect any of the leaks resulting in a sensitivity of 0%. All leaks were apparent on computed tomography (CT) scans on postoperative days 2, 5, 7, 23, and 90. The total cost of the UGI swallow studies was $180,500. Performing routine UGI studies on the first postoperative day following LSG is clearly not cost beneficial. UGI contrast studies are not efficient to screen for suture line leaks. We recommend obtaining a CT scan when there is clinical suspicion for a complication.
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 24035, Mount Scopus, 91240, Jerusalem, Israel, idomiz17@gmail.com.
authors.forename: Ido
authors.initials: I
authors.lastname: Mizrahi
authors.forename: Alp
authors.initials: A
authors.lastname: Tabak
authors.forename: Ronit
authors.initials: R
authors.lastname: Grinbaum
authors.forename: Nahum
authors.initials: N
authors.lastname: Beglaibter
authors.forename: Ahmed
authors.initials: A
authors.lastname: Eid
authors.forename: Natalia
authors.initials: N
authors.lastname: Simanovsky
authors.forename: Nurith
authors.initials: N
authors.lastname: Hiller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003287:Contrast Media; D003362:Cost-Benefit Analysis; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000000981:diagnostic imaging* / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics; D041742:Upper Gastrointestinal Tract / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D003287:Contrast Media
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