Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland.
Obes Surg. 2011 Aug;21(8):1238-42. doi: 10.1007/s11695-010-0284-y.
In up to 4% of laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures, anastomotic leaks occur. Early detection of gastrointestinal leakage is important for successful treatment. Consequently, many centers advocate routine postoperative upper gastrointestinal (UGI) series. The aim of this study was to determine the utility of this practice after LRYGB.
Eight hundred four consecutive patients undergoing LRYGB from June 2000 to April 2010 were analyzed prospectively. The first 382 patients received routine UGI series between the third and fifth postoperative days (group A). Thereafter, the test was only performed when clinical findings (tachycardia, fever, and drainage content) were suspicious for a leak of the gastrointestinal anastomosis (group B; n = 422).
Overall, nine of 804 (1.1%) patients suffered from leaks at the gastroenterostomy. In group A, four of 382 (1%) patients had a leak, but only two were detected by the routine UGI series. This corresponds to a sensitivity of 50%. In group B, the sensitivity was higher with 80%. Specificities were comparable with 97% and 91%, respectively. Routine UGI series cost only 1.6% of the overall costs of a non-complicated gastric bypass procedure. With this leak rate and sensitivity, US $86,800 would have to be spent on 200 routine UGI series to find one leak which is not justified.
This study shows that routine UGI series have a low sensitivity for the detection of anastomotic leaks after LRYGB. In most cases, the diagnosis is initiated by clinical findings. Therefore, routine upper gastrointestinal series are of limited value for the diagnosis of a leak.
在多达 4%的腹腔镜 Roux-en-Y 胃旁路（LRYGB）手术中，会发生吻合口漏。早期发现胃肠道漏对于成功治疗至关重要。因此，许多中心提倡常规术后上消化道（UGI）系列检查。本研究旨在确定 LRYGB 后这种做法的效用。
对 2000 年 6 月至 2010 年 4 月期间连续进行的 804 例 LRYGB 患者进行前瞻性分析。前 382 例患者在术后第 3 至第 5 天接受常规 UGI 系列检查（A 组）。此后，仅在临床发现（心动过速、发热和引流内容物）怀疑胃肠吻合口漏时进行检查（B 组；n=422）。
804 例患者中，共有 9 例（1.1%）发生吻合口漏。A 组 382 例患者中有 4 例漏诊，但仅 2 例通过常规 UGI 系列检查发现。这对应的灵敏度为 50%。B 组的灵敏度较高，为 80%。特异性分别为 97%和 91%。常规 UGI 系列检查仅占非复杂胃旁路手术总费用的 1.6%。以这种漏诊率和灵敏度计算，要发现一个漏诊，需要在 200 例常规 UGI 系列检查中花费 86800 美元，这是不合理的。
本研究表明，常规 UGI 系列检查对 LRYGB 后吻合口漏的检测灵敏度较低。在大多数情况下，诊断是由临床发现开始的。因此，常规上消化道系列检查对漏诊的诊断价值有限。
