Intraoperative iodinated contrast swallow with CT-scan delayed control for detection of early complications in laparoscopic gastric bypass: A case series of 260 cases

Abstract

Background Laparoscopic Roux en Y Gastric Bypass (LRYGB) is a technically challenging operation with potentially severe surgical complications. A large number of tests have been proposed in order to early identify them in the immediate post-operative period but none was completely satisfactory. Actually, there is no data concerning the use of an early diagnostic protocol based on an intraoperative contrast swallow and a CT- scan at 48 h. Methods and analysis From may 2012 to February 2017, 281 patients underwent LRYGB. A 40 cc of iodinated water-soluble contrast (Gastrografin® or Telebrix®) was administered through the orogastric tube 5 min after the blue methylene test while 48 h later, they underwent a CT-scan. The early detection of the contrast liquid in the alimentary or bilio-pancreatic limb, in proximity of it or free in the abdomen were considered signs of bowel obstruction or anastomotic leak. Results 220 were test negative while 35 patients were positive and a second look was carried out successfully. Considering our data, sensitivity was 0,97 (CI 95% = 91,85–100%) while specificity stated at 0,98 (CI 95% = 96,48–99,95%). The positive predictive value was 0,89 (CI 95% = 80,22–99,27%) and the negative predictive value was 0,99 (CI 95% = 98,66–100%). Conclusions This study gives a contribute to the existing issue of fast track in bariatric surgery for the early diagnosis of complications and patients’ readmission or non-discharge. In conclusion, the use of intraoperative iodinated water soluble contrast swallow and abdominal CT-scan at 48 h was a safe and accurate test in order to detect and treat any potential early surgical complication in LRYGB. Highlights