Monika E Hagen1,2, John Diaper3, Jonathan Douissard4, Minoa K Jung4, Leo Buehler4, Florence Aldenkortt3, Gleicy Keli Barcelos3, Philippe Morel4. 1. Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. monikahagen@aol.com. 2. Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland. monikahagen@aol.com. 3. Department of Anesthesiology, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. 4. Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
Abstract
INTRODUCTION: Leak tests using air or methylene blue (MB) for gastrojejunal anastomoses are often performed during gastric bypass surgeries to avoid leaks due to technical errors. Still, early leaks have been reported in the literature. Indocyanine green (ICG) fluorescence with laser excitement makes this dye easily visible even in small amounts, and, thus, may be an excellent agent for leak testing. METHODS: During robotic gastric bypass surgery, a leak test of a gastrojejunal anastomosis was performed with air through a nasogastric tube under manual occlusion of the jejunum. Afterward, 50 ml of a mix of 100 ml sterile water, 2 mg of MB, and 5 mg ICG was injected through the same tube. The entire anastomosis was inspected for integrity under both fluorescent and normal light modes. RESULTS: Leak tests with air and the blend of MB and ICG have been performed in 95 patients from January 2017 to April 2018. No intraoperative leak test-related adverse events occurred. Zero (0%) patients had a positive leak test with air, 0 patients showed MB excretion, and an ICG leak was observed in four (4.2%) patients. No anastomotic complications, including leaks and/or strictures, were found 30 days postoperatively. CONCLUSIONS: Leak tests using a blend of MB and ICG appear to be more sensitive for small defect detection of gastrojejunal anastomoses during robotic gastric bypass surgery. Larger datasets and research that is more stringent are needed to determine the exact clinical value of this new method.
INTRODUCTION: Leak tests using air or methylene blue (MB) for gastrojejunal anastomoses are often performed during gastric bypass surgeries to avoid leaks due to technical errors. Still, early leaks have been reported in the literature. Indocyanine green (ICG) fluorescence with laser excitement makes this dye easily visible even in small amounts, and, thus, may be an excellent agent for leak testing. METHODS: During robotic gastric bypass surgery, a leak test of a gastrojejunal anastomosis was performed with air through a nasogastric tube under manual occlusion of the jejunum. Afterward, 50 ml of a mix of 100 ml sterile water, 2 mg of MB, and 5 mg ICG was injected through the same tube. The entire anastomosis was inspected for integrity under both fluorescent and normal light modes. RESULTS: Leak tests with air and the blend of MB and ICG have been performed in 95 patients from January 2017 to April 2018. No intraoperative leak test-related adverse events occurred. Zero (0%) patients had a positive leak test with air, 0 patients showed MB excretion, and an ICG leak was observed in four (4.2%) patients. No anastomotic complications, including leaks and/or strictures, were found 30 days postoperatively. CONCLUSIONS: Leak tests using a blend of MB and ICG appear to be more sensitive for small defect detection of gastrojejunal anastomoses during robotic gastric bypass surgery. Larger datasets and research that is more stringent are needed to determine the exact clinical value of this new method.
Authors: Mehraneh D Jafari; Kang Hong Lee; Wissam J Halabi; Steven D Mills; Joseph C Carmichael; Michael J Stamos; Alessio Pigazzi Journal: Surg Endosc Date: 2013-02-13 Impact factor: 4.584
Authors: Erik Stenberg; Eva Szabo; Göran Agren; Erik Näslund; Lars Boman; Ami Bylund; Jan Hedenbro; Anna Laurenius; Göran Lundegårdh; Hans Lönroth; Peter Möller; Magnus Sundbom; Johan Ottosson; Ingmar Näslund Journal: Ann Surg Date: 2014-12 Impact factor: 12.969
Authors: Jarmo T Alander; Ilkka Kaartinen; Aki Laakso; Tommi Pätilä; Thomas Spillmann; Valery V Tuchin; Maarit Venermo; Petri Välisuo Journal: Int J Biomed Imaging Date: 2012-04-22