Utility of routine postoperative upper gastrointestinal swallow studies following laparoscopic one anastomosis...

Laparoscopic one anastomosis gastric bypass (OAGB) has grown in popularity in recent years for the treatment of morbid obesity. Despite routine practice, the utility of early postoperative upper gastrointestinal (UGI) swallow studies to detect complications following OAGB has been questioned.

To evaluate the effectiveness and cost-efficiency of performing routine UGI studies on the first postoperative day (POD) after OAGB.

A retrospective cohort analysis of a prospectively collected database was conducted to identify all consecutive patients who underwent OAGB between January 2019 and July 2022. Patient demographics, operative data, and postoperative complication rates were analyzed. Reports from all imaging studies were retrospectively reviewed, and complications were recorded. The institutional review board waived the requirement for informed consent.

A total of 385 patients were included. All patients had an iodine-based contrast swallow study on the first POD. Abnormal findings were observed in 4 patients (1%), none of which were correlated with postoperative complications. Two patients (0.5%) required reoperation due to complications although both had normal UGI study results. Sensitivity and positive predictive value of UGI studies for detecting complications were 0%, while specificity and negative predictive value were 99% and 98%, respectively. Based on hospital charges the overall cost of all the UGI swallow studies performed in our study was 95865 USD.

The study findings showed that performing routine UGI swallow studies on the first POD after laparoscopic OAGB is ineffective in detecting complications and is not cost effective. Normal UGI studies might mislead clinicians in the postoperative period and thus should be omitted in favor of close clinical monitoring.