title: Intraoperative Endoscopy Decreases Postoperative Complications in Laparoscopic Roux-en-Y Gastric Bypass.
abstract: BACKGROUND
  Leak or stenosis following laparoscopic Roux-en-Y gastric bypass (LRYGB) can lead to a major morbidity. We aim to evaluate whether the routine use of intraoperative endoscopy (IOE) can reduce this morbidity.
  
  
  METHODS
  All cases of LRYGB in 2009-2014 were reviewed. In all cases, we perform an IOE. If IOE shows a leak, the area of the leak is re-enforced and IOE is repeated. If the leak persisted, a feeding tube and drains are placed.
  
  
  RESULTS
  During the study period, we performed 342 LRYGB cases. Primary LRYGB represented 82 % (282/342). Average BMI 48 kg/m(2) (range was 35-92) and females represented 76 % (261/342). Our clinical leak rate was 3/342 (0.88 %) in LRYGB (0.4 % in primary and 3.3 % in revisional LRYGB). IOE showed a positive air leak test in six LRYGB cases (1.75 %). We were able to achieve a negative leak test after re-enforcement in 5/6 (83 %) cases, and all those patients had no clinical leak. The patient with persistent air leak test had a clinical leak after surgery. IOE was negative in 336 LRYGB cases and we had two clinical leaks in this group (0.59 %). Our stenosis rate at the gastrojejunostomy was 3/342 (0.88 %). The positive predictive value (PPV) of the performing IOE to detect leaks in LRYGB was 75 % while the negative predictive value was 99.5 %.
  
  
  CONCLUSIONS
  Routine IOE has led to a change in the operative strategy and could be one reason for our low leak and stenosis in laparoscopic Roux-en-Y gastric bypass.
authors: BMI Abu Dhabi, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
authors: Mohammed
authors: M
authors: Al Hadad
authors: Nidal
authors: N
authors: Dehni
authors: Doua
authors: D
authors: Elamin
authors: Maha
authors: M
authors: Ibrahim
authors: Shadin
authors: S
authors: Ghabra
authors: Abdelrahman
authors: A
authors: Nimeri
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D004724:Endoscopy; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies