Intraoperative endoscopy prevents technical defect related leaks in laparoscopic Roux-en-Y gastric bypass: A randomized control trial

Valenzuela-Salazar, Carlos; Rojano-Rodríguez, Martín Edgardo; Romero-Loera, Sujey; Trejo-Ávila, Mario; Bañuelos-Mancilla, Joseph; Délano-Alonso, Roberto; Moreno-Portillo, Mucio

doi:10.1016/j.ijsu.2017.12.024

Cited by 22 publications

(8 citation statements)

References 22 publications

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“…The use of GI endoscopy in patients who have had bariatric surgery is supported by the study by Wilson et al . Interestingly, recent data from an RCT demonstrate the utility of intraoperative endoscopy to detect technical defect–related leaks using the air‐leak test .…”

Section: Executive Summarymentioning

confidence: 96%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

339

464

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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Section: Executive Summarymentioning

confidence: 96%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

339

464

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“…The lack of statistically signi cant difference may be due to the fact that one study is substantially in uencing the sensitivity analysis of the meta-analysis (6). A randomized controlled trial with small sample size found that intraoperative endoscopy could prevent technical defect-related leaks in laparoscopic Roux-en-Y gastric bypass bariatric surgery (29). The signi cance of our study is that IOLT not only has a preventive effect on PAL, but can also signi cantly reduce other postoperative complications, such as postoperative anastomotic-related complications and reoperation rates in gastric surgery.…”

Section: Discussionmentioning

confidence: 63%

A Comparison of the Postoperative Outcomes Between Intraoperative Leak Testing and Non-Intraoperative Leak Testing for Gastric Cancer Surgery: A Systematic Review and Meta-analysis

Tian

Liu

Bai

et al. 2022

Preprint

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Purpose Postoperative anastomotic leakage (PAL) is a serious complication of gastric cancer surgery. Although perioperative management has made significant progress, anastomotic leakage (AL) cannot always be prevented. Intraoperative leak testing (IOLT) may reduce the incidence of PAL and other postoperative complications. The aim of this study is to assess the relationship between IOLT and postoperative surgical complications in gastric cancer surgery. Materials and methods In this meta-analysis, we searched the PubMed, Embase, and Cochrane Library databases for clinical trials to assess the application of IOLT in gastric cancer surgery. Studies comparing the postoperative outcomes of IOLT and non-intraoperative leak testing (NIOLT) were included. Quality assessment, heterogeneity, risk of bias, and the level-of-evidence of the inclusions were evaluated. PAL, anastomosis-related complications, 30-day mortality, and reoperation rates were compared between the IOLT and NIOLT group. Results Our literature search returned 975 results, from which 3 trials (929 total patients) were included in our meta-analysis. Statistical heterogeneity was low. The primary outcome was PAL. IOLT statistically reduced the risk of PAL [3.08% vs9.54%; risk ratios (RR) 0.336, 95% CI, 0.189–0.600, P = 0.000]. It was also found that IOLT can lower the incidence of other postoperative outcomes. Anastomosis-related complication rates [3.94% vs13.14%; risk ratios (RR) 0.323, 95% CI, 0.182–0.572, P = 0.000] were significantly higher in the NIOLT group than the IOLT group. Moreover, IOLT was associated with lower reoperation rates [2.36% vs9.14%; risk ratios (RR) 0.301, 95% CI, 0.145–0.621, P = 0.001]. Conclusion Due to the lower incidence of PAL, anastomosis-related complications, and reoperation rates, IOLT is recommended in gastric cancer surgery.

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“…Another study involving a randomized controlled trial of 100 RYGB patients found patients undergoing IOLT by endoscopy (n = 50) had a significantly lower rate of postoperative anastomotic leak and reoperation as compared to the control (0 vs. 8%, P = 0.04). 10 They also reported that IOLT by endoscopy was associated with a shorter LOS (2.44 vs. 3.46 d, P = .03) and longer operative time (194.10 vs. 159 min, P < .001). In an earlier paper using the MBSAQIP, we found that in the total population of patients who had a drain placed, there was an increased PR of 2.24 (95% confidence interval (CI): 2.2 – 2.29, P < .001) of undergoing a provocative test to check the anastomosis/staple line.…”

Section: Discussionmentioning

confidence: 92%

Endoscopy Used as Provocative Testing in Bariatric Surgery: An Analysis of the Texas Public Use Data File

Clapp

Liggett

et al. 2020

JSLS

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Background: Many bariatric surgeons test the anastomosis and staple lines with some sort of provocative test. This can take the form of an air leak test with a nasogastric tube with methylene blue dye or with an endoscopy. The State Department of Health Statistics in Texas tracks outcomes using the Texas Public Use Data File (PUDF). Methods: We queried the Texas Inpatient and Outpatient PUDFs for 2013 to 2017 to examine the number of bariatric surgeries with endoscopy performed at the same time. We used the International Classification of Diseases Clinical Modification Version 9 (ICD-9-CM) and ICD-10 procedure codes and Current Procedural Terminology for Sleeve Gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) and endoscopy, and the ICD-9-CM and ICD-10 diagnosis codes for morbid obesity. Results: There were 74,075 SG reported in the Texas Inpatient and Outpatient PUDF for the years 2013–2017. Of the SG performed, 5,521 (7.4%) had an intraoperative endoscopy. For the 19,192 LRYGB reported, 1640 (8.6%) underwent LRYGB + endoscopy. This was broken down by SG only vs SG + endoscopy and LRYGB only vs LRYGB + endoscopy. Overall, SG + endoscopy had a significantly shorter length of stay (LOS) vs LRYGB + endoscopy at 1.74 d vs 2.34 d ( P < .001) and a significantly less cost of $71,685 vs $91,093 ( P < .001). Conclusions: A small percentage of SG and LRYGB patients underwent endoscopy for provocative testing over the study period. Provocative testing with endoscopy costs more for SG and LRYGB and was associated with a shorter LOS.

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Intraoperative endoscopy prevents technical defect related leaks in laparoscopic Roux-en-Y gastric bypass: A randomized control trial

Abstract: This study specifically provides evidence that air leak test performed by intraoperative endoscopy is superior to simple visual inspection in preventing technical defect related leaks after laparoscopic Roux-en-Y gastric bypass.

Cited by 22 publications

References 22 publications

A Comparison of the Postoperative Outcomes Between Intraoperative Leak Testing and Non-Intraoperative Leak Testing for Gastric Cancer Surgery: A Systematic Review and Meta-analysis

Endoscopy Used as Provocative Testing in Bariatric Surgery: An Analysis of the Texas Public Use Data File

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