Routine intraoperative leak testing for sleeve gastrectomy: is the leak test full of hot air?

Bingham, Jason; Lallemand, Michaël; Barron, Morgan R.; Kuckelman, John; Carter, Preston; Blair, Kelly; Martin, Matthew J.

doi:10.1016/j.amjsurg.2016.02.002

Cited by 43 publications

(20 citation statements)

References 21 publications

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“…Previous studies by Sethi et al and Celik et al found limited benefit of intraoperative leak testing, with minimal effect on eventual outcome on the diagnosis of postoperative leaks or of the management of the leaks when they did happen [4] , [12] . Similarly, Bingham et al found intraoperative leak test did not predict leak in SG, and postulated that leak testing may increase the risk of postoperative leak [13] . The international consensus group on sleeve gastrectomy attempted but has not reached a definitive conclusion on whether there is a benefit in the use of routine intraoperative leak tests [6] .…”

Section: Discussionmentioning

confidence: 95%

The Birmingham experience of high-pressure methylene blue dye test during primary and revisional bariatric surgery: A retrospective cohort study

Kirby

Macano

Nyasavajjala

et al. 2017

Annals of Medicine &Amp; Surgery

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IntroductionLeak following bariatric surgery continues to be associated with morbidity and rarely mortality. With improvement in surgical techniques and stapler design, leak rates have reduced drastically. Intra-operative high pressure Methylene blue leak test (HPMB) is one of the techniques employed to confirm integrity of anastomoses and staple lines. Despite this, evidence for its use remains limited. We evaluated the role of HPMB in detecting and preventing leaks.MethodsA retrospective cohort of consecutive patients who underwent primary or revisional Laparoscopic Sleeve Gastrectomy (SG) or Laparoscopic Roux-en-Y Gastric bypass (RYGB) under the care of five surgeons in three centres across Birmingham, UK, between 2012 and 2016 were assessed. All patients had routine HPMB at the end of the procedure. Demographics, HPMB positivity, and post operative leaks were recorded.Results924 patients underwent bariatric surgery: 696(75.3%) RYGB, and 225(24.3%) SG. 85(9.2%) were revisional procedures.Two HPMB were positive, which necessitated staple or suture line reinforcement with sutures intra-operatively. The patients had an uneventful recovery. 5 patients had postoperative leaks, all of whom had negative intraoperative HPMB: 3 SG patients; and 2 RYGB patients (gastro-jejunostomy anastomotic leaks). There was no statistically significant relationship between positive HPMB and anastomotic leak (Fishers exact test; p = 1).ConclusionDespite routine use of methylene blue dye test in 924 patients, there were only two positive tests. Whilst HPMB may demonstrate technical failure, this study suggests that there is no role for its routine use in primary bariatric surgery. Discontinuation of this practice would reduce risk of anaphylaxis to the dye, cost, and intra-operative time.

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Section: Discussionmentioning

confidence: 95%

The Birmingham experience of high-pressure methylene blue dye test during primary and revisional bariatric surgery: A retrospective cohort study

Kirby

Macano

Nyasavajjala

et al. 2017

Annals of Medicine &Amp; Surgery

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“…Bingham et al reported the lack of actionable information given from IOLT, as they reported a 2.4% leak rate in SG with none of the leaks being identified on IOLT. 13 Of note, methylene blue was not utilized in this study, as the IOLT testing performed utilized orogastric or endoscopic insufflation. One multicenter study reported a leak incidence of <1% when using air insufflation to diagnose an intraoperative leak; the IOLT was negative in 91% of these patients with only 24% utilizing endoscopy for testing.…”

Section: Discussionmentioning

confidence: 99%

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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“…The international consensus group on sleeve gastrectomy has not reached a definitive conclusion on whether there is a benefit in the use of routine intraoperative leak tests [10]. On the other hand, some studies found the limited benefit of intraoperative leak tests, but the results of these tests could not predict or prevent leakage in all bariatric procedures [13,14]. Intraoperative leak tests can only detect the rare leaks due to technical failures, such as stapler misfire or surgeon inexperience [13,15].…”

Section: Discussionmentioning

confidence: 99%

Bariatrik cerrahide rutin intraoperatif ve postoperatif kaçak testlerine ihtiyaç var mı?

Yardımcı¹,

Yapalak²

2020

Archives of Clinical and Experimental Medicine

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Aim: We aimed to evaluate the efficacy of the results of intraoperative methylene blue test and postoperative upper gastrointestinal contrast graphies for detecting leakage in both primary and revisional bariatric surgery. Methods: Two-hundred-eighty-seven patients, who underwent primary and revision bariatric surgery and routine intraoperative methylene blue test and upper gastrointestinal contrast studies postoperatively for leakage were included in the study. Patients' demographic characteristics, comorbidities, length of hospital stay, operation time, intraoperative, and postoperative complications were analyzed retrospectively. Results: In our study, 256 of 287 (89.1%) patients underwent primary surgery, 221 (75.7%) patients were female, the mean patient age was 38.4 ± 11.9 years, and the mean body mass index was 44.3 ± 7.6 kg/m 2. The number of patients who had previous abdominal surgery and comorbidity was 108 (37.6%) and 149 (51.9%), respectively. Leakage was detected by a methylene blue test in one (0.3%) patient who underwent oneanastomosis gastric bypass surgery. In one (3.2%) patient who underwent revisional surgery with negative results of methylene blue test, leakage was detected on the first postoperative day due to the clinical findings. There was no leakage detected in any patient with postoperative swallow graphies. There was no statistical difference in leakage between primary and revisional surgery groups (p = 0.23). There was no mortality. Conclusion: It could be unnecessary to use postoperative gastrointestinal contrast studies in both primary and revisional bariatric surgery, but the routine use of the intraoperative methylene blue test could be considered useful due to its positive results for the detection of leakage.

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Routine intraoperative leak testing for sleeve gastrectomy: is the leak test full of hot air?

Cited by 43 publications

References 21 publications

The Birmingham experience of high-pressure methylene blue dye test during primary and revisional bariatric surgery: A retrospective cohort study

The Birmingham experience of high-pressure methylene blue dye test during primary and revisional bariatric surgery: A retrospective cohort study

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

Bariatrik cerrahide rutin intraoperatif ve postoperatif kaçak testlerine ihtiyaç var mı?

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