Intraoperative leak testing has no correlation with leak after laparoscopic sleeve gastrectomy

Sethi, Monica; Zagzag, Jonathan; Patel, Karan; Magrath, Melissa; Somoza, Eduardo; Parikh, Manish; Saunders, John K.; Ude-Welcome, Aku; Schwack, Bradley; Kurian, Marina; Fielding, George; Ren-Fielding, Christine

doi:10.1007/s00464-015-4286-7

Cited by 54 publications

(25 citation statements)

References 30 publications

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“…The international sleeve gastrectomy expert panel failed to reach a consensus (48 % consensus) about whether routine intraoperative leak tests should be performed [11]. A recently published study [43] reported that intraoperative leak testing is not correlated with leak due to LSG and is not predictive of the later development of staple line leak, however, it was retrospective study, with unequal groups (1329 vs. 221 patients), operated by different surgeons and different bougies sizes were used. Literature is full of examples of intraoperative positive methylene blue tests with successful management of leak.…”

Section: Intraoperative Provocative Testsmentioning

confidence: 95%

Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

Iossa

Abdelgawad

Watkins

et al. 2016

Langenbecks Arch Surg

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This review reports factors promoting leak and gives technical recommendations to avoid leak after LSG based on the available evidence and expert consensus which encompasses: (1) use a bougie size ≥40 Fr, EL:1, (2) begin the gastric transection 5-6 cm from the pylorus, EL:2-3, (3) use appropriate cartridge colors from antrum to fundus, EL:1, (4) reinforce the staple line with buttress material, EL:1, (5) follow a proper staple line, (6) remove the crotch staples, EL:4, (7) maintain proper traction on the stomach before firing, (8) stay away from the angle of His at least 1 cm, EL:1, (9) check the bleeding from the staple line, (10) perform an intraoperative methylene blue test, EL:4.

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Section: Intraoperative Provocative Testsmentioning

confidence: 95%

Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

Iossa

Abdelgawad

Watkins

et al. 2016

Langenbecks Arch Surg

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“…Some authors have found no correlation with the use of IOLT leading to a decrease in the rate of postoperative leaks. 8 In addition, it is possible that the use of endoscopic IOLT may be underreported or under coded/billed in the state of Texas. This is plausible given that the Center for Medicare & Medicaid Services does not recognize intraoperative endoscopy as separate procedure, thus it is not reimbursed, decreasing the incentive for surgeons to code for the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…This view is supported by other large studies showing no correlation between IOLT and postoperative staple line leak. 8 , 14 The use of endoscopy during SG may decrease secondary findings such as these.…”

Section: Discussionmentioning

confidence: 99%

Endoscopy Used as Provocative Testing in Bariatric Surgery: An Analysis of the Texas Public Use Data File

Clapp

Liggett

et al. 2020

JSLS

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Background: Many bariatric surgeons test the anastomosis and staple lines with some sort of provocative test. This can take the form of an air leak test with a nasogastric tube with methylene blue dye or with an endoscopy. The State Department of Health Statistics in Texas tracks outcomes using the Texas Public Use Data File (PUDF). Methods: We queried the Texas Inpatient and Outpatient PUDFs for 2013 to 2017 to examine the number of bariatric surgeries with endoscopy performed at the same time. We used the International Classification of Diseases Clinical Modification Version 9 (ICD-9-CM) and ICD-10 procedure codes and Current Procedural Terminology for Sleeve Gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) and endoscopy, and the ICD-9-CM and ICD-10 diagnosis codes for morbid obesity. Results: There were 74,075 SG reported in the Texas Inpatient and Outpatient PUDF for the years 2013–2017. Of the SG performed, 5,521 (7.4%) had an intraoperative endoscopy. For the 19,192 LRYGB reported, 1640 (8.6%) underwent LRYGB + endoscopy. This was broken down by SG only vs SG + endoscopy and LRYGB only vs LRYGB + endoscopy. Overall, SG + endoscopy had a significantly shorter length of stay (LOS) vs LRYGB + endoscopy at 1.74 d vs 2.34 d ( P < .001) and a significantly less cost of $71,685 vs $91,093 ( P < .001). Conclusions: A small percentage of SG and LRYGB patients underwent endoscopy for provocative testing over the study period. Provocative testing with endoscopy costs more for SG and LRYGB and was associated with a shorter LOS.

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“…Interestingly leaks may occur as a late event, days or even weeks postoperatively [3] , [4] , [5] . High pressure methylene blue leak test (HPMB) has been routinely used to assess anastomotic integrity following bariatric surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

The Birmingham experience of high-pressure methylene blue dye test during primary and revisional bariatric surgery: A retrospective cohort study

Kirby

Macano

Nyasavajjala

et al. 2017

Annals of Medicine &Amp; Surgery

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IntroductionLeak following bariatric surgery continues to be associated with morbidity and rarely mortality. With improvement in surgical techniques and stapler design, leak rates have reduced drastically. Intra-operative high pressure Methylene blue leak test (HPMB) is one of the techniques employed to confirm integrity of anastomoses and staple lines. Despite this, evidence for its use remains limited. We evaluated the role of HPMB in detecting and preventing leaks.MethodsA retrospective cohort of consecutive patients who underwent primary or revisional Laparoscopic Sleeve Gastrectomy (SG) or Laparoscopic Roux-en-Y Gastric bypass (RYGB) under the care of five surgeons in three centres across Birmingham, UK, between 2012 and 2016 were assessed. All patients had routine HPMB at the end of the procedure. Demographics, HPMB positivity, and post operative leaks were recorded.Results924 patients underwent bariatric surgery: 696(75.3%) RYGB, and 225(24.3%) SG. 85(9.2%) were revisional procedures.Two HPMB were positive, which necessitated staple or suture line reinforcement with sutures intra-operatively. The patients had an uneventful recovery. 5 patients had postoperative leaks, all of whom had negative intraoperative HPMB: 3 SG patients; and 2 RYGB patients (gastro-jejunostomy anastomotic leaks). There was no statistically significant relationship between positive HPMB and anastomotic leak (Fishers exact test; p = 1).ConclusionDespite routine use of methylene blue dye test in 924 patients, there were only two positive tests. Whilst HPMB may demonstrate technical failure, this study suggests that there is no role for its routine use in primary bariatric surgery. Discontinuation of this practice would reduce risk of anaphylaxis to the dye, cost, and intra-operative time.

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Intraoperative leak testing has no correlation with leak after laparoscopic sleeve gastrectomy

Abstract: Intraoperative leak testing has no correlation with leak due to laparoscopic sleeve gastrectomy and is not predictive of the later development of staple line leak.

Cited by 54 publications

References 30 publications

Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

Endoscopy Used as Provocative Testing in Bariatric Surgery: An Analysis of the Texas Public Use Data File

The Birmingham experience of high-pressure methylene blue dye test during primary and revisional bariatric surgery: A retrospective cohort study

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