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Routinemäßige Durchleuchtungsuntersuchungen nach bariatrischen Operationen

Routine fluoroscopic investigations after primary bariatric surgery

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Zusammenfassung

Hintergrund

Klammernaht- oder Anastomoseninsuffizienzen nach bariatrischen Eingriffen stellen für die Patienten eine ernstzunehmende Komplikation dar. Die Röntgendurchleuchtungsuntersuchung mit oraler Aufnahme eines wasserlöslichen Kontrastmittels (DL-U) ist eine Möglichkeit, Insuffizienzen zu diagnostizieren. Ziel dieser Studie ist die Bewertung routinemäßiger DL-U nach primären bariatrischen Eingriffen im Hinblick auf die Detektion postoperativer Komplikationen.

Methodik

Von 01/2009 bis 12/2014 wurden 658 bariatrische Eingriffe durchgeführt. 442 Primäreingriffe, darunter 307 laparoskopische Sleeve-Gastrektomien (LSG) und 135 laparoskopische Roux-Y-Magenbypässe (LRYGB), wurden in die Studie eingeschlossen. Bis 12/2012 erfolgte eine routinemäßige DL-U zwischen dem 1. und 3. postoperativen Tag unabhängig von der klinischen Symptomatik. Die Auswertung der DL-U erfasste die Erkennung von Komplikationen wie Insuffizienzen und Stenosen.

Ergebnisse

Im Untersuchungszeitraum traten 8 Klammernahtinsuffizienzen (2,6 %) nach Sleeve-Gastrektomie auf. Des Weiteren wurden je eine Insuffizienz der Gastrojejunostomie (0,7 %) und eine der Jejunojejunostomie (0,7 %) nach den Magenbypässen diagnostiziert. Alle Patienten wurden durch die klinische Symptomatik auffällig. In einem Fall wurde die Insuffizienz in der Routine-DL-U nachgewiesen, in 9 Fällen war die postoperative Routineröntgendiagnostik unauffällig. Bei keinem Patienten erfolgte ein radiologischer Insuffizienznachweis bei unauffälligem klinischem Befund.

Schlussfolgerung

Routinemäßige, frühpostoperative DL-U nach bariatrischen Eingriffen sind zur Detektion von Insuffizienzen beim asymptomatischen Patienten nicht geeignet.

Abstract

Background

Staple line and anastomotic leakages are life-threatening complications after bariatric surgery. Upper gastrointestinal (GI) tract X-ray examination with oral administration of a water-soluble contrast agent can be used to detect leaks. The aim of this study was to evaluate the impact of routine upper GI tract fluoroscopy after primary bariatric surgery.

Methods

Between January 2009 and December 2014 a total of 658 bariatric interventions were carried out of which 442 were primary bariatric operations. Included in this single center study were 307 sleeve gastrectomies and 135 Roux-en-Y gastric bypasses. Up to December 2012 upper GI tract fluoroscopy was performed routinely between the first and third postoperative days and the detection of leakages was evaluated.

Results

In the investigation period 8 leakages (2.6 %) after sleeve gastrectomy, 1 anastomotic leakage in gastrojejunostomy and 1 in jejunojejunostomy after Roux-en-Y gastric bypass occurred. All patients developed clinical symptoms, such as abdominal pain, tachycardia or fever. In one case the leakage was detected by upper GI fluoroscopy and in nine cases radiological findings were unremarkable. No leakages were detected in asymptomatic patients.

Conclusion

Routine upper GI fluoroscopy is not recommended for uneventful postoperative courses after primary bariatric surgery.

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Literatur

  1. Aurora AR, Khaitan L, Saber AA (2012) Sleeve gastrectomy and the risk of leak: a systematic analysis of 4888 patients. Surg Endosc 26:1509–1515

    Article  PubMed  Google Scholar 

  2. Aretxabala X, Leon J, Wiedmaier G et al (2011) Gastric leak after sleeve gastrectomy: analysis of its management. Obes Surg 21:1232–1237

    Article  PubMed  Google Scholar 

  3. Blachar A, Federle MP (2002) Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery in patients who are morbidly obese: findings on radiography and CT. Am J Roentgenol 179:1437–1442

    Article  Google Scholar 

  4. Bohdjalian A, Langer FB, Shakeri-Leidenmühler S et al (2010) Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg 20:535–540

    Article  PubMed  Google Scholar 

  5. Brockmeyer JR, Simon TE, Jacob RK et al (2012) Upper gastrointestinal swallow study following bariatric surgery: institutional review and review of the literature. Obes Surg 22:1039–1043

    Article  PubMed  Google Scholar 

  6. Buchwald H, Oien DM (2013) Metabolic/bariatric surgery worldwide 2011. Obes Surg 23:427–436

    Article  PubMed  Google Scholar 

  7. Carter JT, Tafreshian S, Campos GM et al (2007) Routine upper GI series after gastric bypass does not reliably identifiy anasomotic leaks or predict stricture formation. Surg Endosc 21:2172–2177

    Article  CAS  PubMed  Google Scholar 

  8. Casella G, Soricelli E, Rizzelo M et al (2009) Nonsurgical treatment of staple line leaks after sleevegastrectomy. Obes Surg 19:821–826

    Article  CAS  PubMed  Google Scholar 

  9. Chandler RC, Srinivas G, Chintapalli KN et al (2008) Imaging in bariatric surgery: a guide to postsurgical anatomy and common complications. AJR 190:122–135

    Article  PubMed  Google Scholar 

  10. Deitel M, Gagner M, Erickson AL et al (2011) Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis 7:749–759

    Article  PubMed  Google Scholar 

  11. Doerfer J, Meyer T, Klein P et al (2010) The importance of radiological controls of anastomoses after upper gastrointestinal tract surgery – a retrospective cohort study. Patient Saf Surg 4:17

    Article  PubMed  PubMed Central  Google Scholar 

  12. Doraiswamy A, Rasmussen JJ, Pierce J et al (2007) The utility of routine postoperative upper GI series following laparoscopic gastric bypass. Surg Endosc 21:2159–2162

    Article  PubMed  Google Scholar 

  13. Gagner M, Deitel M, Erickson AL et al (2013) Survey on laparoscopic sleeve gastrectomy (LSG) at the fourth International consensus summit on sleeve gastrectomy. Obes Surg 23:213–217

    Article  Google Scholar 

  14. Gnecchi M, Bella G, Pino AR et al (2013) Usefulness of X-Ray in the detection of complications and side effects after laparoscopic sleeve gastrectomy. Obes Surg 23:456–459

    Article  CAS  PubMed  Google Scholar 

  15. Jurowic C, Thalheimer A, Seyfried F et al (2011) Gastric leakage after sleeve gastrectomy – clinical presentation and therapeutic options. Langenbecks Arch Surg 396:981–987

    Article  Google Scholar 

  16. Köckerling F, Schug-Pass C (2009) Gastroscopically controlled laparoscopic sleeve gastrectomy. Obes Facts 2:15–18

    Article  PubMed  Google Scholar 

  17. Lyass S, Khalli TM, Cunneen S et al (2004) Radiological studies after laparoscopic Roux-en-Y-gastric bypass routine or selective. Am Surg 70:918–921

    PubMed  Google Scholar 

  18. Madan AK, Stoecklein HH, Temovits CA et al (2007) Predictive value of upper gastrointestinal studies versus clinical signs for gastrointestinal leaks after laparoscopic gastric bypass. Surg Endosc 21:194–196

  19. Mason EE, Ito C (1967) Gastric bypass in obesity. Surg Clin North Am 47:1345–1351

    CAS  PubMed  Google Scholar 

  20. Nocca D, Krawczykowsky D, Bomans B et al (2008) A prospective multicenter study of 163 sleevegastrectomies: results at 1 and 2 years. Obes Surg 18:560–565

    Article  CAS  PubMed  Google Scholar 

  21. Runkel N, Colombo-Benkmann M, Hüttl TP et al (2011) Bariatric surgery. Dtsch Arztebl Int 108:341–346

  22. Singh R, Fisher BL (2003) Sensitivity and specificity of postoperative upper GI series following gastric bypass. Obes Surg 13:73–75

    Article  PubMed  Google Scholar 

  23. Stroh C, Birk D, Flade-Kuthe R et al (2009) Results after sleeve gastrectomy – Data from a nationwide survey on bariatric surgery. Obes Surg 19:632–640

  24. The ASMBS Clinical Issues Committee (2009) ASMBS guideline on the prevention and detection of GI leak after gastric bypass including the role of imaging and surgical exploration. Surg Obes Relat Dis 5:293–296

  25. Tonouchi H, Mohri Y, Tanaka K et al (2007) Diagnostic sensitivity of contrast swallow for leakage after gastric resection, World J Surg 31:128–131

    Article  PubMed  Google Scholar 

  26. Tucker ON, Szomstein S, Rosenthal RJ (2008) Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg 12:662–667

    Article  CAS  PubMed  Google Scholar 

  27. Whaby M, Salama AF, Elezaby AF et al (2013) Is Routine Postoperative Gastrografin Study Needed After Laparoscopic Sleeve Gastrectomy? Experience of 712 Cases. Obes Surg 23:1711–1717

    Article  Google Scholar 

  28. White S, Han SH, Lewis C et al (2008) Selective approach to use of upper gastrooesophgeal imaging study after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 4:122–125

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Danksagung

Die Autoren danken Fr. M. Yazbek, Städtisches Klinikum Karlsruhe, für die Unterstützung bei der Datenerfassung und -auswertung.

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Authors and Affiliations

  1. Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland

    D. Gärtner, A. Ernst, K. Fedtke, A. Schöttler & M.R. Schön

  2. Klinik für Gefäß- und Thoraxchirurgie, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland

    J. Jenkner

  3. Institut für diagnostische und interventionelle Radiologie, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland

    P. Reimer

  4. Klinik und Poliklinik für Endokrinologie und Nephrologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    M. Blüher

Authors
  1. D. Gärtner
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  2. A. Ernst
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  3. K. Fedtke
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  7. M. Blüher
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  8. M.R. Schön
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Corresponding author

Correspondence to D. Gärtner.

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Interessenkonflikt

D. Gärtner ist als Referent und Flying Doc für die Firma Johnson & Johnson MEDICAL GmbH tätig. A. Ernst, K. Fedtke, J. Jenkner, A. Schöttler, P. Reimer, M. Blüher und M.R. Schön geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Gärtner, D., Ernst, A., Fedtke, K. et al. Routinemäßige Durchleuchtungsuntersuchungen nach bariatrischen Operationen. Chirurg 87, 241–246 (2016). https://doi.org/10.1007/s00104-015-0063-3

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  • DOI: https://doi.org/10.1007/s00104-015-0063-3

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