Examination of the Efficacy and Safety of Intraoperative Gastroscopic Testing of the Gastrojejunal Anastomosis in Laparoscopic Roux Y Gastric Bypass Surgery

Abstract

The laparoscopic Roux Y gastric bypass (LRYGB) is one of the most often performed bariatric surgical intervention. Intraoperative gastroscopy (IOG) seems to be reliable to decrease the leakage rate of gastrojejunal anastomosis (GJA) and of gastric pouch (GP). Our aim was to test the efficacy and the safety of this method. Two hundred fifty-two LRYGB operations were performed in our institution between 1 January 2008 and 1 January 2010. IOG is routinely made to test the integrity of GJA and of GP. Patients' dates were retrospectively analysed. The intragastric pressure developed during gastroscopy in humans was measured and compared with pressure values led to destruction (positive air test) of the GJA and/or GP in animal models (hybrid pigs). Stomach and bowel wall samples from the test animals without pressure strain, with pressure strain developed at gastroscopy in humans and with pressure strains led to destruction of GJA and/or GP were histologically examined. IOG resulted in six of our cases (2.3%) positive air test. There was no anastomosis insufficiency in postoperative period. Mean pressure during IOG was 32 mmHg, mean time of examination was 3.8 min and mean maximal pressure was 43 mmHg in humans. The mean pressure leading to positive air test in pigs was 150 mmHg. We could not detect any microscopical difference between stomach and jejunum samples without pressure strain and after pressure strain developed in humans during the gastroscopy. We conclude that intraoperative gastroscopy is an effective and safe method to test the integrity of GJA and GP in LRYGB surgery.

Indications and benefits of intraoperative esophagogastroduodenoscopy.

“…Conveniently, IOG offers direct visual control with the air leak test, which can be enforced by navigation of the surgical suture or even endoscopic reinforcement of the insufficiency of the stapled anastomosis or suture (hemoclips, over-the-scope clips, endoscopic suture). The general scientific problem of insufficient evidence remains, with the exception of bariatric surgery, which offers large series of promising data [ 71 , 72 ]. The reliability of extrapolation to the oncosurgical anastomotic complication remains unclear [ 73 ].…”

Indocyanine Green Fluorescence Angiography During Laparoscopic Bariatric Surgery: A Pilot Study

“…The leak etiology is multifactorial with a sharing of mechanical and ischemic causes which has not been fully clarified yet ( 10 , 11 ). In the literature, the mortality rate related to unrecognized leaks reaches 17% ( 7 , 12 ). Leaks are associated with increased length of hospital stay and greater readmission rate leading to increased costs ( 13 ).…”

Clinical Efficacy of Jejunojejunostomy Leak Test Using Methylene Blue During Laparoscopic Roux-en-Y Gastric Bypass on Post-Operative Leak Rate

“…For detecting leaks, intra-operative assessment of anastomosis can be done using dye, air, or other gas by endoscopy or orogastric tube to distend the site. Thus, it can be repaired during the procedure (11)(12)(13). The aim of this study was to examine the preventive effect of routine intraoperative gastrojejunal and jejunojejunal leak tests on postoperative leak rates after LRYGB.…”