Methylene Blue or Upper GI, Which is More Effective for Detecting Leaks in Gastric Bypass Patients?

Postoperative leaks from the staple lines are a serious complication after laparoscopic Roux-en-Y gastric bypass (RYGB) that results in morbidity and could even lead to mortality. Bariatric surgeons have several tools to assess this adversity. There have been debates as to which method is more superior and furthermore whether these methods should be routinely or selectively used. The aim of our study is to evaluate and compare whether methylene blue or upper gastrointestinal (UGI) study is more effective in detecting an anastomotic leak after RYGB.

Between May 2013 and March 2014, 119 patients underwent laparoscopic RYGB. Linear staplers were used to create the gastrojejunostomy and the jejunojejunostomy. All patients underwent routine UGI studies and methylene blue challenges on postoperative day 1. A retrospective review of a prospectively collected database was performed for all patients.

Of the 105 patients in this study there were 83 females (79.0%) and 22 males (21.0%). Mean age was 45.2±10.7 years (range, 21 to 66 y) and mean preoperative body mass index was 47.8±7.9 kg/m (range, 35.7 to 76.4 kg/m) at the time of procedure. Mean length of hospital stay was 3.2±6.0 days (range, 1 to 53 d).Four (3.8%) patients were found to have leaks postoperatively, but no leakage was detected in any of the initial routine UGI studies or methylene blue challenges. Both patient were diagnosed with clinical signs and underwent oversewing of the leak sites.

UGI studies and methylene blue challenges had no significant difference in detecting a postoperative leak. Furthermore, these tests may have limited utility and may warrant adjuncts to aid in leak detection.