Cost and validity of early postoperative contrast swallow after laparoscopic adjustable gastric banding

To assess the validity and cost of early routine upper gastrointestinal (UGI) studies after laparoscopic adjustable gastric banding (LAGB) at a university hospital in the United States. Today, although there is widespread use of LAGB, and it is considered a safe procedure, it also can result in some specific early complications. In most centers, an UGI series after bariatric surgery is performed to rule out these potentially dangerous complications.

From March 2006 to July 2010, 183 LAGB procedures were performed by a single surgeon. All data were collected prospectively in a computerized database and reviewed retrospectively. The patients underwent water-soluble UGI studies during the early postoperative phase (2-24 h) to exclude gastrointestinal perforation, obstruction, and gastric band malposition.

No intraoperative complications occurred. One conversion to an open procedure was required because of massive adhesions. A total of 21 postoperative complications (11.5%) occurred. None of the 183 patients who underwent an early UGI series experienced leakage, gastric band malposition, or slippage. The only radiologic abnormality was a stomal obstruction (.5%) requiring reoperation. The total cost for the 183 UGI studies was $54,900. The mean hospital stay was .5 day (range .1-5.6). Approximately 90% of patients were discharged within the first 24 hours.

The fear of acute perforation or obstruction has been the rationale for obtaining UGI studies after LAGB. We found this to be expensive and of limited value in an experienced center and have created a decisional algorithm to determine when its use is appropriate for symptomatic patients.