Routine Early Fluoroscopy and Clinical Observations Following Laparoscopic Roux-En-Y Gastric Bypass for Obesity Fail to Predict Subsequent Anastomotic Leakage

Abstract

One of the most feared complications of Roux-en-Y gastric bypass is anastomotic leak; early identification of which is associated with reduced morbidity and mortality. Efforts to identify patients who may suffer from such leaks have focused around routine early fluoroscopy, post-operative blood tests and clinical signs. We aimed to assess the role of these factors in our patient cohort. A retrospective cohort analysis was performed in order to assess the sensitivity, specificity and negative/positive predictive values of routine early fluoroscopy, post-operative blood tests and clinical signs in predicting anastomotic failure. 108 patients were identified for whom 107 files were available. Leaks occurred in 4 patients (3.7%), none of whom were identified on fluoroscopy. Of the clinical signs and blood tests examined, only average heart rate was significantly different in the leak ground (94.5 versus 108.5 beats per minute, p = 0.02). Nevertheless, as with other measurements, a low positive predictive value was noted. Fluoroscopy in our cohort of patients was not useful in identifying subsequent anastomotic leaks. The low positive and high negative predictive value of clinical signs and routine blood tests means that stratifying patients who may benefit from fluoroscopy is also challenging. Therefore, identifying patients who will subsequently leak remains a challenge with a high index of suspicion remaining in the main technique used to identify leaks.