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Is Routine Postoperative Gastrografin Study Needed After Laparoscopic Sleeve Gastrectomy? Experience of 712 Cases

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Abstract

Background

The current standard of care is to perform a postoperative gastrografin study following laparoscopic sleeve gastrectomy (LSG) to detect leakage or obstruction. This study evaluated the usefulness of this routine procedure.

Methods

A retrospective chart review was performed in December 2012. All patients had routine intraoperative methylene blue testing to check for possible leakage from the staple line, and any leaking points were oversewn. We also performed postoperative contrast study (gastrografin) routinely in the first 24–48 h for all patients.

Results

From June 2007 to December 2012, 712 cases underwent LSG during the study period. Patients included in this study were 556 women (78.1 %) and 156 men (21.9 %). The mean age was 35 years. The mean BMI was 48 kg/m2. The operative time was 107 ± 29 min, and there were no conversions to open surgery. Intraoperative methylene blue test detected leakage in 28 cases (3.93 %). Postoperative contrast study (gastrografin) was negative for leakage in all cases. Computed tomography (CT) scan with oral contrast study detected leakage in 1.4 % (ten cases); none of these cases were detected by regular contrast study.

Conclusions

Our study showed that intraoperative methylene blue test for leakage is a very sensitive and effective method for detecting leakage during sleeve gastrectomy and should be done routinely in all cases. Routine postoperative contrast study is not needed to detect leakage unless clinically indicated in selected cases, and in such cases contrast-enhanced CT scans are the modality of choice.

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Conflict of Interest

Dr. Mahmoud Wahby, Dr. Asaad Salama, Dr. Ayman Elezaby, Dr. Farouk Belgrami, Dr. Hitham El-Kaffas, M Al-Katary, and Dr. Mohamed Abd Ellatif have no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, Jahra Hospital, Kuwait, Kuwait

    M. Wahby & F. Belgrami

  2. Department of Digestive Surgery, TBRI, Cairo, Egypt

    A. F. Salama & A. F. Elezaby

  3. General Surgical Department, Faculty of Medicine, Mansoura University, 35516 El-Gomhoria St, Mansoura, Egypt

    M. E. Abd Ellatif, H. F. El-Kaffas & M. Al-Katary

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  1. M. Wahby
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  2. A. F. Salama
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  3. A. F. Elezaby
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  4. F. Belgrami
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  5. M. E. Abd Ellatif
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  6. H. F. El-Kaffas
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  7. M. Al-Katary
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Correspondence to M. E. Abd Ellatif.

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Wahby, M., Salama, A.F., Elezaby, A.F. et al. Is Routine Postoperative Gastrografin Study Needed After Laparoscopic Sleeve Gastrectomy? Experience of 712 Cases. OBES SURG 23, 1711–1717 (2013). https://doi.org/10.1007/s11695-013-1013-0

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