Abstract
Objective: To evaluate the efficacy of a simple intra-operative test (white banner test) for the detection of a leak during laparoscopic sleeve gastrectomy. Design: A prospective case series study. Setting: Obesity center at Soran private hospital, Erbil, Iraq, during the period from January 2017 to June 2019. Participants: eighty patients underwent the white banner test during laparoscopic sleeve gastrectomy. The records of intraoperative findings and post-operative follow up were analyzed. Patients and methods: After completing the sleeve process and hemostasis, a gauze of 4*12 cm was introduced through the 12mm trocar and displayed along the course of remaining sleeved stomach, nasogastric tube inserted to the upper portion of the stomach, compression of the pylorus by grasper against the vertebrae, 100 milliliters of saline stained by methylene blue dye were injected slowly by the anesthetist through the nasogastric tube, waiting for 30 seconds, any discoloration of the gauze was recorded and the site of leak (if any) was identified and managed. If the gauze appeared white, gauze withdrawn and the procedure finished. Results: In 80 patients, only two patients showed a blue spot at the gauze, which were fixed by suture. In all other patients, the gauzes were completely clean and (white). Postoperatively no early leak was detected. Conclusion: This is a simple and not time-consuming intraoperative procedure that can be used to detect intra-operative leaks during laparoscopic sleeve gastrectomy. Keywords: obesity. Sleeve gastrectomy. Leak. Intraoperative test. Acknowledgment: The author thanks all the staff who works at the obesity center at Soran Private Hospital for their unlimited support for this study. The study received no outside funding and no relevant financial disclosures. The researcher declares that there is no conflict of interest regarding the publication of this research
Highlights
Obesity is a medical condition in which excess body fat accumulates in the body causes a negative impact on health[1]
Based on the fact that operative detection of a technically induced staple line defect can be treated with prompt closure, a wide number of surgeons adopt the routine use of intra operative leak test during surgery for detection of leaks including methylene blue test, air test or esophago-gastroduodenoscopy (OGD)[9,10]
The procedure done as follows: After completing the stapling and ensure adequate hemostasis, a series of gauzes (2 or 3) measured 4*12 cm were introduced through the 12mm trocar and displayed throughout the sleeved portion of remaining stomach from the gastro-esophageal junction down to antrum, the nasogastric tube of 18 F inserted and pointed at the upper portion of stomach, flow was transiently blocked with bowel clamp compressing at the pyloric channel, 50 to 100 ml of normal saline containing 5 mL of methylene blue dye is injected slowly by the anesthetist through the nasogastric tube, the distension of the stomach is noticed and maintained for 30 seconds, the gauze examined for any spot discoloration
Summary
Obesity is a medical condition in which excess body fat accumulates in the body causes a negative impact on health[1]. . حمییم فعالیت إخشاء بسیظ داخل العملیت (اخخباس الشایت البیضاء) للکشف عه الخسشب أثىاء حکمیم المعذة بالمىظاس:الهذف .. دساست حالاث حسلسلیت:تصميم 7102 ُ إلى یُوی7102 خلال الفخشة مه یىایش، العشاق، أسبیل، مشکض السمىت فی مسخشفى سُسان الخاص:الإعذاد حم حسدیل الىخائح أثىاء العملیت. ثماوُن مشیضا خضعُا لاخخباس الشایت البیضاء أثىاء عملیت حکمیم المعذة بالمىظاس:المشارکىن
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