title: Intraoperatively Testing the Anastomotic Integrity of Esophagojejunostomy Using Methylene Blue.
abstract: BACKGROUND
  Intraoperative testing of gastrointestinal anastomosis effectively ensures anastomotic integrity. This study investigated whether the routine use of methylene blue intraoperatively identified leaks to reduce the postoperative proportion of clinical leaks.
  
  
  METHODS
  This study retrospectively analyzed consecutive total gastrectomies performed from January 2007 to December 2014 in a university hospital setting by a general surgical group that exclusively used the methylene blue test. All surgeries were performed for gastric or junctional cancers (n = 198). All reconstructions (Roux-en Y esophagojejunostomy) were performed using a stapler. The methylene blue test was used in 108 cases (group 1) via a nasojejunal tube. No test was performed for the other 90 cases (group 2). Intraoperative leakage rate, postoperative clinical leakage rate, length of hospitalization, and mortality rate were the outcome measures.
  
  
  RESULTS
  The intraoperative leakage rate was 7.4% in group 1. The postoperative clinical leakage rate was 8.6%. The postoperative clinical leakage rate was 3.7% in group 1 and 14.4% in group 2 (p = 0.007). There were no postoperative clinical leaks when an intraoperative leak led to concomitant intraoperative repair. The median length of hospital stay was 6 days in group 1 and 8 days in group 2 (p < 0.001). One death occurred in each group. No test-related complications were observed.
  
  
  CONCLUSIONS
  The methylene blue test for esophagojejunostomy is a safe and reliable method for the assessment of anastomosis integrity, especially in cases with difficult esophagojejunostomic construction.
authors.affiliation: 1 Department of General Surgery, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Celik
authors.affiliation: 2 General Surgery Clinic, Van Training and Research Hospital, Van, Turkey.
authors.forename: N
authors.initials: N
authors.lastname: Almalı
authors.affiliation: 1 Department of General Surgery, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Aras
authors.affiliation: 1 Department of General Surgery, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey.
authors.forename: Ö
authors.initials: Ö
authors.lastname: Yılmaz
authors.affiliation: 1 Department of General Surgery, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey.
authors.forename: R
authors.initials: R
authors.lastname: Kızıltan
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000517:prevention & control; D004396:Coloring Agents; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007431:Intraoperative Complications / Q000175:diagnosis*; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue
keywords: Methylene blue test; anastomosis integrity; esophagojejunostomy