The gastrojejunostomy is one of the main points for complications after Roux-n-Y gastric bypass (RYGB). This anastomosis is the only anastomosis constructed to be as small as possible in general surgery. This, and other factors, may lead to leaks and complications that are clearly related to increased costs and mortality after bariatric surgery.
The keys to a successful gastrojejunostomy are good clinical and technical expertise, plus some tips and tricks that have been discussed in this book. Despite this, even if we construct a perfect anastomosis, it may fail and it may lead to a leak. Intraoperative and postoperative testing have been historically discussed and considered mandatory at the end of the surgery. Nowadays we have several reports and increasing evidence that it might not be so important after surgery, and we are beginning to discuss its indications during the procedures.
For the intraoperative time, we may have three different ways of testing: air and/or methylene blue through orogastric tube and intraoperative endoscopy. All three possibilities may show a leak or a disruption in the suture, but endoscopy also adds the hemostasis checking and a real image of how stenotic we have constructed the anastomosis.
After surgery, there are several choices: methylene blue, contrast studies. As time goes by, we have moved from a systematic indication of these studies to a selective one. We have learnt that all these studies have a limited sensitivity and specificity, so we have to be guided primarily by the clinical signs.
Leak Intraoperative Air leak test Methylene blue Endoscopy CT scan Upper GI series
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