Mucosal tonometry as early warning of gastrojejunal leak in laparoscopic Roux-en-y gastric bypass

The laparoscopic Roux-en-Y gastric bypass (LRYGB) is the standard surgical procedure for morbidly obese patients in many centers worldwide. The gastrojejunal anastomosis (GJA) leak has a 2 % incidence and a 10 % mortality. This prospective study aims to test gastroenteric tonometry as an early warning of GJA leak risk. A nasogastric tube with tonometric capability was used to monitor gastroenteric mucosal carbon dioxide partial pressure (PgeCO2) in 32 consecutive patients during the first 24 to 72 postoperative hours after LRYGB. Sensitivity was 100 %, specificity 96.77 %, likelihood ratio 31, and area under receiver operating characteristic curve 0.984. The only early gastrojejunal leak occurred to the patient with maximal PgeCO2 (13.9 kPa) of the cohort. The remaining patients kept a PgeCO2 below 11 kPa except one; none of these developed early GJA leak. Mucosal gastroenteric tonometry may be a useful predictor of early GJA leak of the LRYGB.