HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Carucci, L. R. Articles by Sugerman, H. J. Search for Related Content PubMed PubMed Citation Articles by Carucci, L. R. Articles by Sugerman, H. J.

Roux-en-Y Gastric Bypass Surgery for Morbid Obesity: Evaluation of Postoperative Extraluminal Leaks with Upper Gastrointestinal Series¹

¹ From the Departments of Radiology (L.R.C., M.A.T., R.C.C.) and Surgery (E.J.D., J.M.K., H.J.S.), Virginia Commonwealth University Medical Center, 1250 E Marshall St, Main Hospital, 3rd Floor, Rm 417, PO Box 980615, Richmond, VA 23298-0615. Received September 8, 2004; revision requested November 15; revision received February 4, 2005; final version accepted March 1. Address correspondence to L.R.C. (e-mail: lcarucci{at}vcu.edu).

Purpose: To retrospectively evaluate the radiographic features of extraluminal leak after Roux-en-Y gastric bypass (RYGBP) surgery at upper gastrointestinal (GI) examinations in a large series of patients and to determine morbidity and mortality in those patients with leak.

Materials and Methods: The investigational review board approved this HIPAA-compliant study, and the need for patient informed consent was waived. Radiologic database review revealed 1202 upper GI studies performed over a 4-year period in 906 patients after RYGBP. Extraluminal leak was identified in 50 patients. Two patients with leaks that occurred before the study period were excluded. Of the remaining 48 patients, 12 were men and 36 were women (mean age, 45 years; range, 26–64 years). Surgery had been laparoscopic in 23 patients and open in 25. Upper GI studies were analyzed by two radiologists in consensus for the origin, extent, and severity of leaks and associated findings. Chart review was performed to determine clinical course, treatment, and outcome.

Results: Fifty extraluminal leaks were detected in 48 of 904 patients (5.3%) at upper GI examinations. All leaks were identified within 28 days, and, in 37 of 48 patients (77%), leakage was diagnosed within 1 week of surgery. The majority of leaks (n = 37) originated from the gastrojejunal anastomosis. Leaks also occurred at the distal portion of the esophagus (n = 5), the gastric pouch (n = 5), the oversewn jejunum (n = 2), and the distal anastomosis (n = 1). Leaks extended into the left upper quadrant in 30 patients. Obstruction or ileus was present in 35 of 48 patients (73%). Leak into the excluded stomach was observed in 15 of 48 patients. The occurrence of extraluminal leak prolonged hospital stays; organ failure occurred in 14 (29%) and death in three (6%) of the 48 patients.

Conclusion: Extraluminal leak was identified on upper GI series in 48 of 904 patients (5.3%) after RYGBP for morbid obesity. Extraluminal leak most commonly arises from the gastrojejunal anastomosis and extends into the left upper quadrant. Extraluminal leak affects morbidity and mortality.

© RSNA, 2006

This article has been cited by other articles:

				L. R. Carucci, R. C. Conklin, and M. A. Turner Roux-en-Y Gastric Bypass Surgery for Morbid Obesity: Evaluation of Leak into Excluded Stomach with Upper Gastrointestinal Examination Radiology, August 1, 2008; 248(2): 504 - 510. [Abstract] [Full Text] [PDF]

				R. C. Chandler, G. Srinivas, K. N. Chintapalli, W. H. Schwesinger, and S. R. Prasad Imaging in Bariatric Surgery: A Guide to Postsurgical Anatomy and Common Complications Am. J. Roentgenol., January 1, 2008; 190(1): 122 - 135. [Abstract] [Full Text] [PDF]