A significant and potentially deadly complication of the Roux-en-Y gastric bypass is leakage from the gastrojejunostomy.
Dr Sekhar and researchers evaluated the efficacy of intraoperative endoscopy in preventing postoperative anastomotic leakage.
The investigative team study enrolled 340 consecutive patients undergoing laparoscopic gastric bypass procedures performed from 2001 to 2004.
In all cases, an endoscopist performed video gastroscopy.
The integrity of the gastrojejunostomy using air insufflation of the pouch after distal clamping of the Roux limb was evaluated.
Intraoperative leaks were repaired and the anastomosis was retested.
The investigators collected and analysed demographic, operative, and endoscopic data.
|Endoscopic evaluation of the gastrojejunostomy detected 16% of intraoperative leaks|
Logistic regression was used in both univariate and multivariate modelling.
The team used the methods to identify independent preoperative variables associated with the presence of intraoperative leak.
Model parameters were estimated by the maximum likelihood method.
From these estimates, odds ratios with 95% confidence intervals were computed.
The investigators found no postoperative anastomotic leaks or mortalities in these series.
Overall, endoscopic evaluation of the gastrojejunostomy resulted in the detection of 16% of intraoperative leaks.
The team noted a difference in the incidence of intraoperative leakage for patients, with 21% older than 40 years, and 10% in those younger than 40 years.
In the initial 91 cases, the gastrojejunostomy was performed by the end-to-end anastomosis technique.
The team reported that the subsequent 249 were performed with a combination of linear stapling and handsewn technique.
There was a non-significant trend to less leakage in 12% with end-to-end anastomosis.
Age remained an independent risk factor for leak detected intraoperatively in the multivariate logistic regression model after adjusting for covariates.
The investigators observed that more than 40 years of age increased the risk of intraoperative leakage by about 2 times.
The rate of postoperative anastomotic stricture was the same among patients detected with an intraoperative leak and those without.
Dr Sekhar‘s team commented, “Endoscopic evaluation of the gastrojejunostomy is a sensitive and reliable technique for demonstrating anastomotic integrity and preventing postoperative morbidity after gastric bypass.”