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

Yıl 2020, , 21 - 24, 20.03.2020

Erkan Yardımcı , Yunus Yapalak

https://doi.org/10.25000/acem.654279

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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