Intraoperative endoscopy for laparoscopic Roux-en-Y gastric bypass: leak test and beyond

The aim of this study is to determine the role of intraoperative endoscopy in identifying gastrojejunostomy leak in laparoscopic Roux-en-Y gastric bypass (LRNYGB) and to define other roles that can be achieved by this diagnostic maneuver.

A retrospective chart review of all patients who underwent LRNYGB at both Cleveland Clinic (USA) and Adan Hospital (Kuwait) was undertaken. All operations were performed by 2 surgeons (B.C. and F.A.).We analyzed the following parameters in the patients: mean age, estimated blood loss, average hospital stay, the number of patients who had intraoperative leaks, and those who developed intraoperative pouch bleeding.

Between July 2004 and January 2009, 290 patients (244 women-85% and 46 men-15%) were operated upon with a mean age of 42 years (range: 19 to 61 y). The average body mass index was 48 kg/m2 (range: 35 to 65 kg/m2), and the average American Society of Anesthesiology classification of 3 (range: 2 to 4). Mean estimated blood loss of 95 mL (range: 27 to 310 mL) and the mean operative time was 165 minutes (range: 102 to 348 min). The average hospital stay was 3 days (range: 2 to 13 d). Eleven patients (3.7%) developed intraoperative leaks that were controlled intraoperatively. Ten patients (3.4%) developed intraoperative pouch bleeding, in 6 of them the bleeding vessel was controlled laparascopically. No documented postoperative leak in this series of patients. One patient (0.34%) underwent diagnostic laparoscopy for clinical suspicion of a leak which could not be identified.

Intraoperative endoscopy for LRNYGBP may reduce the leak rate postoperatively and also, may minimize postoperative endoscopy and surgical intervention for gastrointestinal bleeding.