The Utility of Contrast Studies and Drains in the Management of Patients after Roux-en-Y Gastric Bypass

Background: The role of routine post-operative contrast examination (UGI) and drainage of the gastrojejunostomy after Roux-en-Y gastric bypass (RYGBP) is controversial.The authors determined if early routine post-operative UGI detects occult anastomotic leaks, thereby altering treatment and withholding early feeding. Methods: Prospective data on 100 consecutive patients who underwent RYGBP from September 1998 to September 2000 was reviewed. Closed suction drains were routinely used. Within 36 hr postoperatively, all patients underwent UGI to evaluate the gastrojejunostomy. Patients were given liquids if the UGI showed no leak, and drains were removed 24 hr later. A blinded radiologist reviewed all the UGI. Results: 87 women and 13 men underwent 75 open and 25 laparoscopic RYGBP. BMI was 52.0 kg/m². 3 patients whose UGI showed a leak were treated nonoperatively with antibiotics, maintenance of drains, nasogastric tube and NPO. 2 of those patients developed purulent drainage within 24 hr after the UGI. None of the three patients required reoperation. 4 UGI were not available for the blinded reviewer who graded the remaining as satisfactory (94) and unsatisfactory (2). This reviewer disputed a leak in 1 of 3 previously reported leaks and reported a leak in a previously negative study. The latter patient subsequently required surgery for an uncontrolled leak. Conclusions: UGI can be used to withhold early oral intake in patients with radiographic leaks that would otherwise progress to clinically significant leaks. Surgical drains facilitate the non-operative management of such anastomotic leaks. Planned early UGI and surgical drains minimize the morbidity of anastomotic leaks after bariatric surgery.