Value of routine postoperative gastrographin contrast swallow studies after laparoscopic gastric banding.
HYPOTHESIS: Laparoscopic adjustable gastric banding (LAGB) effectively treats morbid obesity and yields improved quality of life with low morbidity and mortality rates. The current standard of care is to perform a postoperative gastrographin study. This study evaluated a series of patients to determine the usefulness of this routine procedure. DESIGN: Retrospective analysis. SETTING: Texas Tech University Health Sciences Center, Lubbock. PATIENTS: A series of 100 patients who had undergone LAGB between August 1, 2006, and February 28, 2007, were evaluated by medical record review and a blinded examination of the upper gastrointestinal tract. MAIN OUTCOME MEASURES: Laboratory test results and patient vital signs. RESULTS: The mean age of the patients was 42 years. The mean initial body mass index (calculated as weight in kilograms divided by height in meters squared) was 50.0. Median excess weight loss was 49.0% after 12 months. Three patients did not undergo gastrographin studies because of a history of allergic reactions to the dye. No differences between the opinion of the surgeon and that of the original radiologist were uncovered. The 97 patients who underwent gastrographin studies lacked leaks; the only radiologic abnormalities were slow passage and reflux in 23 patients. No alteration in patient care resulted. The total cost for the 97 patients was $49 470. The 95% confidence interval for 0 useful results for 97 studies is 0.00 to 0.03; at best, 3.2% of patients undergoing this expensive study would have garnered some benefit. CONCLUSION: Routine postoperative upper gastrointestinal tract studies are expensive and of limited value. Instead of relying on them to detect leaks, which are extremely rare after LAGB, reliance should be given to the presence or absence of tachypnea and tachycardia, as is currently done for Roux-en-Y gastric bypass. In this way there will be a cost savings and the potential to make LAGB a same-day procedure.
Frezza, EE; Mammarappallil, JG; Witt, C; Wei, C; Wachtel, MS
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