Advertisement

Obesity Surgery

, 21:1592 | Cite as

Examination of the Efficacy and Safety of Intraoperative Gastroscopic Testing of the Gastrojejunal Anastomosis in Laparoscopic Roux Y Gastric Bypass Surgery

  • Elemer MohosEmail author
  • Elizabeth Schmaldienst
  • Doris Richter
  • Manfred Prager
Clinical Report

Abstract

The laparoscopic Roux Y gastric bypass (LRYGB) is one of the most often performed bariatric surgical intervention. Intraoperative gastroscopy (IOG) seems to be reliable to decrease the leakage rate of gastrojejunal anastomosis (GJA) and of gastric pouch (GP). Our aim was to test the efficacy and the safety of this method. Two hundred fifty-two LRYGB operations were performed in our institution between 1 January 2008 and 1 January 2010. IOG is routinely made to test the integrity of GJA and of GP. Patients’ dates were retrospectively analysed. The intragastric pressure developed during gastroscopy in humans was measured and compared with pressure values led to destruction (positive air test) of the GJA and/or GP in animal models (hybrid pigs). Stomach and bowel wall samples from the test animals without pressure strain, with pressure strain developed at gastroscopy in humans and with pressure strains led to destruction of GJA and/or GP were histologically examined. IOG resulted in six of our cases (2.3%) positive air test. There was no anastomosis insufficiency in postoperative period. Mean pressure during IOG was 32 mmHg, mean time of examination was 3.8 min and mean maximal pressure was 43 mmHg in humans. The mean pressure leading to positive air test in pigs was 150 mmHg. We could not detect any microscopical difference between stomach and jejunum samples without pressure strain and after pressure strain developed in humans during the gastroscopy. We conclude that intraoperative gastroscopy is an effective and safe method to test the integrity of GJA and GP in LRYGB surgery.

Keywords

Obesity LRYGB Intraoperative gastroscopy Efficacy Safety Animal model 

Notes

Conflict of Interest

Any commercial interest of the authors is disclosed.

References

  1. 1.
    Kligman MD. Intraoperative endoscopic pneumatic testing for gastrojejunal anastomosis integrity during laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21:1403–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Fullum TM, Aluka KJ, Turner PL. Decreasing anastomotic and staple line leaks after laparoscopic Roux Y gastric bypass. Surg Endosc. 2009;23:1403–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Thodiyil PA, Yenumula P, Rogula T, et al. Selective nonoperative management of leaks after gastric bypass. Ann Surg. 2008;248:782–92.PubMedCrossRefGoogle Scholar
  4. 4.
    Alaedeen D, Madan AK, Ro CY, et al. Intraoperative endoscopy and leaks after laparoscopic Roux-en-Y gastric bypass. Am Surg. 2009;75:485–8.PubMedGoogle Scholar
  5. 5.
    Madan AK, Martinez JM, Menzo EL, et al. Omental reinforcement for intraoperative leak during laparoscopic Roux-en-Y gastric bypass. In: Surgical Congress Atlanta, Georgia, February. 2009.Google Scholar
  6. 6.
    Saber AA, Scahrf KR, Turk AZ, et al. Early experience with intraluminal reinforcement of stapled gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:525–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Saber AA, Jackson O. Omental wrap: a simple technique for reinforcement of the gastrojejunostomy during Roux-en-Y gastric bypass. Obes Surg. 2007;17:15–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Champion JK, Hunt T, DeLisle N. Role of routine intraoperative endoscopy in laparoscopic bariatric surgery. Surg Endosc. 2002;16:1663–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Marshall JS, Srivastava A, Gupta SK, et al. Roux-en-Y gastric bypass leak complications. Arch Surg. 2003;138:520–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Shin RB. Intraoperative endoscopic test resulting in no postoperative leaks from the gastric pouch and gastrojejunal anastomosis in 366 laparoscopic Roux-en-Y gastric bypasses. Obes Surg. 2004;14:1064–9.CrossRefGoogle Scholar
  11. 11.
    Ballesta C, Berindoague R, Cabrera M. Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:623–30.PubMedCrossRefGoogle Scholar
  12. 12.
    Amarasinghe DC. Air test as an alternative to methylene blue test for leaks. Obes Surg. 2002;12:295–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2011

Authors and Affiliations

  • Elemer Mohos
    • 1
    Email author
  • Elizabeth Schmaldienst
    • 1
  • Doris Richter
    • 1
  • Manfred Prager
    • 1
  1. 1.Department of General SurgeryTerritory Hospital OberwartOberwartAustria

Personalised recommendations