Are routine intraoperative and postoperative leakage tests needed in bariatric surgery?

Abstract

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/m². 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 one-anastomosis 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.

Keywords

• Bariatric surgery,leakage,methylene blue,radio contrast imaging

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

Öz

Amaç: Primer ve revizyonel bariatrik cerrahide kaçak tanısı için uygulanan intraoperatif metilen mavisi testi ile postoperatif üst gastrointestinal sistem kontrastlı grafilerin etkinliklerini ve sonuçlarını değerlendirmeyi amaçladık.

Yöntemler: Primer ve revizyonel cerrahi uygulanan, kaçak tespiti için rutin olarak intraoperatif metilen mavisi testi ile postoperatif üst gastrointestinal kontrastlı grafi yapılan 287 hasta çalışmaya dahil edildi. Hastaların demografik özellikleri, komorbid hastalıkları, hastanede yatış süresi, ameliyat süresi, intraoperatif ve postoperatif komplikasyonlar retrospektif olarak incelendi.

Bulgular: Çalışmamızdaki 287 hastanın 256’sına (%89,1) primer cerrahi uygulandı ve hastaların 221’i (%75,7) kadın, ortalama yaş 38.4±11.9 yıl ve ortalama beden kitle indeksi 44.3± 7.6 kg /m² idi. Daha önce abdominal cerrahi geçiren ve komorbid hastalığı olan hasta sayıları sırasıyla 108 (%37,6) ve 149 (%51,9) idi. Bir (% 0,3) tek-anastomozlu gastrik bypass olgusunda metilen mavisi testinde kaçak tespit edildi. Revizyon cerrahisi uygulanan 1 (%3,2) olguda, metilen mavisi testinde kaçak tespit edilmeyip, postoperatif 1. gün klinik bulgulara göre kaçak tespit edildi. Postoperatif kontrastlı grafi sonuçlarında hiçbir hastada kaçak tespit edilmedi. Primer ve revizyonel cerrahi uygulanan olgular arasında görülen kaçaklarda istatistiksel olarak anlamlı fark tespit edilmedi (p=0,230). Mortalite yok idi.

Sonuç: Primer ve revizyonel bariatrik cerrahide postoperatif gastrointestinal kontrast çalışmalarının kullanılmasına gerek olmayabilir, ancak kaçak tespitindeki pozitif sonuçları nedeniyle intraoperatif metilen mavisi testinin rutin olarak uygulanması düşünülebilir.

Anahtar Kelimeler

• Bariatrik cerrahi,kaçak,metilen mavisi,radyo kontrastlı görüntüleme

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