title: Routine versus selective contrast imaging to identify the need for early re-intervention following laparoscopic fundoplication: A retrospective cohort study.
abstract: BACKGROUND
  The prompt recognition of complications is essential in reducing morbidity following anti-reflux surgery. Consequently, many centres employ a policy of routine post-operative contrast studies. The study aimed to examine whether routine contrast studies more effectively recognised early post-operative complications following anti-reflux surgery compared with selective use.
  
  
  METHODS
  This was a retrospective analysis of 240 adults who had undergone primary anti-reflux surgery. Selective use of water-soluble contrast swallows was employed for 115 patients (Group 1) while 125 patients (Group 2) had routine studies.
  
  
  RESULTS
  10 (0.9%) patients from Group 1 underwent contrast studies, four (40%) of which were abnormal. Routine studies in Group 2 identified thirty-two abnormalities (27%) however the inter-group difference was not significant (p = 0.32). Only one case from group 2 required immediate re-intervention. This was not statistically significant (p = 0.78). Multivariate analysis found no significant association between selective or routine imaging and re-intervention rates. One patient from group 2 presented three days following discharge with wrap migration requiring reoperation despite a normal post-operative study.
  
  
  CONCLUSIONS
  Routine use of contrast imaging following anti-reflux and hiatus hernia surgery is not necessary. It does not identify a significantly greater number of post-operative complications in comparison to selective use. Additionally, routine use of contrast studies does not ensure the diagnosis of all complications in the post-operative period.
authors.affiliation: Department of Oesophago-Gastric Surgery, Central Manchester University Hospitals NHS Foundation Trust, UK.
authors.forename: Khalid
authors.initials: K
authors.lastname: Shahzad
authors.affiliation: Department of Oesophago-Gastric Surgery, Central Manchester University Hospitals NHS Foundation Trust, UK.
authors.forename: Ashok
authors.initials: A
authors.lastname: Menon
authors.affiliation: Department of Oesophago-Gastric Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Turner
authors.affiliation: Department of Oesophago-Gastric Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Ward
authors.affiliation: Department of Oesophago-Gastric Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, UK.
authors.forename: Kishore
authors.initials: K
authors.lastname: Pursnani
authors.affiliation: Department of Oesophago-Gastric Surgery, Central Manchester University Hospitals NHS Foundation Trust, UK. Electronic address: bilal.alkhaffaf@cmft.nhs.uk.
authors.forename: Bilal
authors.initials: B
authors.lastname: Alkhaffaf
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D005260:Female; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine
keywords: Fundoplication; Gastroesophageal reflux; Hiatal hernia; Postoperative complications