Maden Ata, Kupietzky Amram, Zimand Yakira, Bar-Moshe Yehonatan, Dover Roi, Juster Eyal Yonathan, Drayer Lichtman Moriya, Grinbaum Ronit, Mazeh Haggi, Mizrahi Ido
Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9765422, Israel.
Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel.
World J Gastrointest Surg. 2025 Jul 27;17(7):107092. doi: 10.4240/wjgs.v17.i7.107092.
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.
近年来，腹腔镜单吻合口胃旁路术（OAGB）在治疗病态肥胖方面越来越受欢迎。尽管这是常规做法，但术后早期上消化道（UGI）吞咽研究用于检测OAGB术后并发症的效用受到了质疑。
评估在OAGB术后第一天（POD）进行常规UGI研究的有效性和成本效益。
对前瞻性收集的数据库进行回顾性队列分析，以确定2019年1月至2022年7月期间所有连续接受OAGB的患者。分析患者的人口统计学、手术数据和术后并发症发生率。对所有影像学研究报告进行回顾性审查，并记录并发症。机构审查委员会免除了知情同意的要求。
共纳入385例患者。所有患者在术后第一天均进行了碘造影剂吞咽研究。4例患者（1%）观察到异常结果，但均与术后并发症无关。2例患者（0.5%）因并发症需要再次手术，尽管两者的UGI研究结果均正常。UGI研究检测并发症的敏感性和阳性预测值为0%，而特异性和阴性预测值分别为99%和98%。根据医院收费，我们研究中进行的所有UGI吞咽研究的总成本为95865美元。
研究结果表明，在腹腔镜OAGB术后第一天进行常规UGI吞咽研究在检测并发症方面无效且不具有成本效益。正常的UGI研究可能会在术后误导临床医生，因此应省略，转而进行密切的临床监测。
