Radiological studies after laparoscopic Roux-en-Y gastric bypass: routine or selective?

Early detection of complications after laparoscopic Roux-en-Y gastric bypass (LRYGB) can be difficult because of the subtle clinical findings in obese patients. Consequently, routine postoperative upper gastrointestinal contrast studies (UGI) have been advocated for detection of leak from the gastrojejunostomy. The medical records of 368 consecutive patients undergoing LRYGB were analyzed to determine the efficacy of selective use of radiological studies after LRYGB. Forty-one patients (11%) developed signs suggestive of complications. Of the 41 symptomatic patients, two were explored urgently, 39 (10%) had radiological studies, and 16 of them (41%) were diagnosed with postoperative complications. Overall morbidity of the series was 4.8 per cent. Four patients (1.1%) developed a leak from the gastrojejunostomy and were correctly diagnosed by computerized tomography (CT). The sensitivity and specificity of CT in determining leak was 100 per cent, with positive and negative predictive value of 100 per cent. The mortality of the series was 0 per cent. No radiologic studies were performed in asymptomatic patients, and no complications developed in these patients. Our results show that selective radiological evaluation in patients with suspected complications after LRYGB is safe. High sensitivity makes CT the test of choice in patients with suspected complication after LRYGB. Routine radiological studies are not warranted.