Surgical Endoscopy

, Volume 21, Issue 12, pp 2159–2162 | Cite as

The utility of routine postoperative upper GI series following laparoscopic gastric bypass

  • Asok Doraiswamy
  • Jason J. Rasmussen
  • Jonathan Pierce
  • William Fuller
  • Mohamed R. Ali



Routine upper gastrointestinal (UGI) studies following laparoscopic Roux-en-Y gastric bypass (LRYGBP) have the potential advantage of early identification of anastomotic complications. The aim of our study was to evaluate the efficacy of routine postoperative UGI and its relationship to clinical outcomes.


Over a three-year period, 516 patients underwent LRYGBP followed by routine postoperative UGI studies. Data were collected on the results of the UGI, clinical parameters, and patient outcomes. Study groups were composed of patients with a normal UGI (Group I, n = 455), abnormal UGI not requiring further intervention (Group II, n = 36), and abnormal UGI requiring further intervention (Group III, n =25). Statistical significance was set at α= 0.05 level for all analyses.


The three study groups were not statistically different in mean age (42 years) or body mass index (BMI) (45) and were predominantly female (90%). Most patients had an uneventful postoperative course. Anastomotic complications (gastrojejunostomy and jejunojejunostomy) were uncommon (1.3%). The sensitivity of the UGI for anastomotic leak in this study was low (33%). However, all patients with alimentary limb obstruction (n = 3) had UGI evidence of this complication. Of the 516 UGI reports, there were only 25 (4.8%, Group III) that were abnormal and required some form of intervention ranging from serial imaging (84%) to reoperation (16%). Of the various clinical parameters examined, the patients in Group III demonstrated a significantly higher prevalence of fever (p < 0.001), tachycardia (p < 0.01), vomiting (p < 0.001), and postoperative day 1 leukocytosis (p < 0.005).


Our data suggest that routine UGI after LRYGBP has limited utility as it may result in unnecessary intervention based on false-positive results or a delay in treatment based on false-negative results. We advocate selective UGI imaging following LRYGBP based on the patient’s clinical factors, particularly fever and tachycardia.


Bariatric Laparoscopy Obesity Gastric bypass Upper GI Radiology 


  1. 1.
    Albrecht RJ, Pories WJ (1999) Surgical intervention for the severely obese. Baillieres Best Pract Res Clin Endocrinol Metab 13:149–172CrossRefPubMedGoogle Scholar
  2. 2.
    Freys SM, Tigges H (2001) Quality of life following laparoscopic gastric banding in patients with morbid obesity. J Gastrointest Surg 5:401–407CrossRefPubMedGoogle Scholar
  3. 3.
    Schauer PR, Ikramuddin S (2001) Laparoscopic surgery for morbid obesity. Surg Clin North Am 81:1145–1179CrossRefPubMedGoogle Scholar
  4. 4.
    Pope GD, Birkmeyer JD (2002) National trends in utilization and in hospital outcomes of bariatric surgery. J Gastrointest Surg 6:855–861CrossRefPubMedGoogle Scholar
  5. 5.
    Serafini F, Anderson W (2002) The utility of contrast studies and drains in the management of patients after Roux-en-Y gastric bypass. Obes Surg 12:34–38CrossRefPubMedGoogle Scholar
  6. 6.
    Sims TL, Mullican MA (2003) Routine upper gastrointestinal gastrografin swallow after laparoscopic Roux-en-Y gastric bypass. Obes Surg 13:66–72CrossRefPubMedGoogle Scholar
  7. 7.
    Lyass S, Khalili T (2004) Radiological studies after laparoscopic Roux-en-Y gastric bypass: routine or selective? Am Surg 70:918–921PubMedGoogle Scholar
  8. 8.
    Singh R, Fisher BL (2003) Sensitivity and specificity of postoperative upper GI series following gastric bypass. Obes Surg 1:73–75CrossRefGoogle Scholar
  9. 9.
    Katsani V, Leeth R (2005) Water soluble upper GI based on clinical findings is reliable to detect anastomotic leaks after laparoscopic gastric bypass. Am Surg 71:916–919Google Scholar
  10. 10.
    Hamilton EC, Sims TL (2003) Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc 17:679–684CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Asok Doraiswamy
    • 1
  • Jason J. Rasmussen
    • 1
  • Jonathan Pierce
    • 1
  • William Fuller
    • 1
  • Mohamed R. Ali
    • 1
    • 2
  1. 1.Department of SurgeryUniversity of California, DavisSacramentoUSA
  2. 2.Minimally Invasive Surgery, Department of SurgeryUniversity of California, DavisSacramentoUSA

Personalised recommendations