BackgroundLaparoscopic Roux en Y Gastric Bypass (LRYGB) is a technically challenging operation with potentially severe surgical complications. A large number of tests have been proposed in order to early identify them in the immediate post-operative period but none was completely satisfactory. Actually, there is no data concerning the use of an early diagnostic protocol based on an intraoperative contrast swallow and a CT- scan at 48 h. Methods and analysisFrom may 2012 to February 2017, 281 patients underwent LRYGB. A 40 cc of iodinated water-soluble contrast (Gastrografin® or Telebrix®) was administered through the orogastric tube 5 min after the blue methylene test while 48 h later, they underwent a CT-scan. The early detection of the contrast liquid in the alimentary or bilio-pancreatic limb, in proximity of it or free in the abdomen were considered signs of bowel obstruction or anastomotic leak. Results220 were test negative while 35 patients were positive and a second look was carried out successfully. Considering our data, sensitivity was 0,97 (CI 95% = 91,85–100%) while specificity stated at 0,98 (CI 95% = 96,48–99,95%). The positive predictive value was 0,89 (CI 95% = 80,22–99,27%) and the negative predictive value was 0,99 (CI 95% = 98,66–100%). ConclusionsThis study gives a contribute to the existing issue of fast track in bariatric surgery for the early diagnosis of complications and patients' readmission or non-discharge. In conclusion, the use of intraoperative iodinated water soluble contrast swallow and abdominal CT-scan at 48 h was a safe and accurate test in order to detect and treat any potential early surgical complication in LRYGB.