Intraoperative Endoscopic Test Resulting in No Postoperative Leaks from the Gastric Pouch and Gastrojejunal Anastomosis in 366 Laparoscopic Roux-en-Y Gastric Bypasses

Background: Postoperative leak from the gastric pouch and the anastomosis are leading causes of morbidity and mortality after gastric bypass. Many modalities have been emerging to prevent this complication. 326 consecutive laparoscopic Roux-en-Y gastric bypasses (LRYGBP) were analyzed in a two-surgeon practice and found no incidence of leaks from the gastric pouch (GP) and the gastrojejunal anastomosis (GJA) with intraoperative endoscopic testing. Methods: 328 consecutive RYGBP performed in antecolic fashion from March 2003 to January 2004 were analyzed. 326 (99%) were performed laparoscopically. After creating a 15 to 25 cc gastric pouch, integrity of the GP and GJA was tested for leak under saline submersion with endoscopic insufflation and placement of a bowel clamp on the intestinal limb distal to the GJA. Suture repair of apparent leak was performed if needed. Results: Of 326 consecutive LRYGBP utilizing the endoscopic leak test, there was no incidence of leak from the GP or GJA. There was one leak from the jejuno-jejunosotmy which was repaired laparoscopically on postoperative day #1. There was no incidence of leaks in the 2 open RYGBPs. Conclusions: Many "leak prophylaxis" measures have been emerging to prevent this potentially devastating complication. However, checking the GP and GJA with a simple endoscopic test can minimize the incidence of leaks after LRYGBP.