Advertisement

Early Routine Upper Gastrointestinal Contrast Study Following Bariatric Surgery: an Indispensable Postoperative Care or a Medicolegal Heritage?

  • Francesco Pennestrì
  • Francesca Prioli
  • Luca SessaEmail author
  • Pierpaolo Gallucci
  • Luigi Ciccoritti
  • Piero Giustacchini
  • Brunella Barbaro
  • Maria Gabriella Brizi
  • Pietro Princi
  • Rocco Bellantone
  • Marco Raffaelli
Brief Communication
  • 43 Downloads

Abstract

Concerns still exist regarding the role of early routine upper gastrointestinal contrast study (UGI) after bariatric procedures for detection of early complications. We reviewed our database to identify patients who underwent laparoscopic primary or redo surgery (previously placement of adjustable gastric banding), between January 2012 and December 2017. All the patients underwent UGI within 48 h after surgery. Among 1094 patients, early UGI was abnormal in 5 patients: in 4 cases a leak (one false positive) and in one case stenosis (one true positive) were suspected. In this clinical setting, five leaks were observed and required surgical re-exploration: 3 correctly identified and 2 not detected at UGI. Overall, 3 patients developed anastomotic stenosis. Our data suggest that early routine UGI after bariatric procedures has limited utility.

Keywords

Upper gastrointestinal contrast study Bariatric surgery Medicolegal issue Personalized medicine Leakage Stenosis Complications 

Notes

Authors’ Contributions

• Study conception and design: Francesco Pennestrì, Luca Sessa

• Acquisition of data: Pierpaolo Gallucci, Luigi Ciccoritti, Piero Giustacchini, Pietro Princi

• Analysis and interpretation of data: Brunella Barbaro, Maria Gabriella Brizi

• Drafting of manuscript: Francesco Pennestrì, Francesca Prioli

• Critical revision of manuscript: Rocco Bellantone, Marco Raffaelli

Compliance with Ethical Standard

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Mizrahi I, Tabak A, Grinbaum R, et al. The utility of routine postoperative upper gastrointestinal swallow studies following laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(9):1415–9.  https://doi.org/10.1007/s11695-014-1243-9.CrossRefGoogle Scholar
  2. 2.
    Kim J, Azagury D, Eisenberg D, et al. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis. 2015;11(4):739–48.  https://doi.org/10.1016/j.soard.2015.05.001.CrossRefGoogle Scholar
  3. 3.
    Cottam D, Lord J, Dallal RM, et al. Medicolegal analysis of 100 malpractice claims against bariatric surgeons. Surg Obes Relat Dis. 2007;3(1):60–6. discussion 66-7CrossRefGoogle Scholar
  4. 4.
    Madan AK, Stoecklein HH, Ternovits CA, et al. Predictive value of upper gastrointestinal studies versus clinical signs for gastrointestinal leaks after laparoscopic gastric bypass. Surg Endosc. 2007;21(2):194–6.CrossRefGoogle Scholar
  5. 5.
    Doraiswamy A, Rasmussen JJ, Pierce J, et al. The utility of routine postoperative upper GI series following laparoscopic gastric bypass. Surg Endosc. 2007;21(12):2159–62.CrossRefGoogle Scholar
  6. 6.
    Schiesser M, Guber J, Wildi S, et al. Utility of routine versus selective upper gastrointestinal series to detect anastomotic leaks after laparoscopic gastric bypass. Obes Surg. 2011;21(8):1238–42.  https://doi.org/10.1007/s11695-010-0284-y.CrossRefGoogle Scholar
  7. 7.
    Agnes A, Callari C, Raffaelli M. The unexpected evolution of an expected complication: hemophagocytic lymphohistiocytosis. Obes Surg. 2017;27(1):205–7.  https://doi.org/10.1007/s11695-016-2430-7.CrossRefGoogle Scholar
  8. 8.
    Spaniolas K, Kasten KR, Sippey ME, et al. Pulmonary embolism and gastrointestinal leak following bariatric surgery: when do major complications occur? Surg Obes Relat Dis. 2016;12(2):379–83.  https://doi.org/10.1016/j.soard.2015.05.003.CrossRefGoogle Scholar
  9. 9.
    Musella M, Cantoni V, Green R, et al. Efficacy of postoperative upper gastrointestinal series (UGI) and computed tomography (CT) scan in bariatric surgery: a meta-analysis on 7516 patients. Obes Surg. 2018;28(8):2396–405.  https://doi.org/10.1007/s11695-018-3172-5.CrossRefGoogle Scholar
  10. 10.
    Bingham J, Shawhan R, Parker R, et al. Computed tomography scan versus upper gastrointestinal fluoroscopy for diagnosis of staple line leak following bariatric surgery. Am J Surg. 2015;209(5):810–4.  https://doi.org/10.1016/j.amjsurg.2015.01.004.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Francesco Pennestrì
    • 1
  • Francesca Prioli
    • 1
    • 2
  • Luca Sessa
    • 1
    Email author
  • Pierpaolo Gallucci
    • 1
  • Luigi Ciccoritti
    • 1
  • Piero Giustacchini
    • 3
  • Brunella Barbaro
    • 4
    • 5
  • Maria Gabriella Brizi
    • 5
    • 6
  • Pietro Princi
    • 1
  • Rocco Bellantone
    • 1
    • 2
  • Marco Raffaelli
    • 1
    • 2
  1. 1.U.O.C. Chirurgia Endocrina e MetabolicaFondazione Policlinico Universitario A Gemelli IRCCSRomeItaly
  2. 2.Istituto di Semeiotica ChirurgicaUniversità Cattolica del Sacro CuoreRomeItaly
  3. 3.Department of Endocrine and Metabolic SurgeryMater Olbia HospitalOlbiaItaly
  4. 4.U.O.C. Radiologia Diagnostica e Interventistica GeneraleFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
  5. 5.U.O.S.A. Radiologia d’UrgenzaFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
  6. 6.Istituto di RadiologiaUniversità Cattolica del Sacro CuoreRomeItaly

Personalised recommendations