Intraoperative Endoscopy Decreases Postoperative Complications in Laparoscopic Roux-en-Y Gastric Bypass
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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.
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.
During the study period, we performed 342 LRYGB cases. Primary LRYGB represented 82 % (282/342). Average BMI 48 kg/m2 (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 %.
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.
KeywordsBariatric surgery LRYGB Intraoperative endoscopy Leak Stricture
Conflict of Interest
Drs. Al Hadad, Dehni, Elamin, Ibrahim, Ghabra, and Nimeri have no conflicts of interest or financial ties to disclose. For this type of study, a formal consent is not required.
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