Gastric Bypass pp 177-180 | Cite as

Gastrojejunostomy Testing

  • Amador García Ruiz de Gordejuela
  • Jordi Pujol Gebelli


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 


  1. 1.
    Quezada N, Maiz C, Daroch D, Funke R, Sharp A, Boza C, et al. Effect of early use of covered self-expandable endoscopic stent on the treatment of postoperative stapler line leaks. Obes Surg. 2015;25:1816. Scholar
  2. 2.
    Amarasinghe DC. Air test as an alternative to methylene blue test for leaks. Obes Surg. 2002;12:295–6. Scholar
  3. 3.
    Al Hadad M, Dehni N, Elamin D, Ibrahim M, Ghabra S, Nimeri A. Intraoperative endoscopy decreases postoperative complications in laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2015;25:1711–5. Scholar
  4. 4.
    Schiesser M, Guber J, Wildi S, Guber I, Weber M, Muller MK. Utility of routine versus selective upper gastrointestinal series to detect anastomotic leaks after laparoscopic gastric bypass. Obes Surg. 2011;21:1238–42. Scholar
  5. 5.
    Madan AK, Stoecklein HH, Ternovits CA, Tichansky DS, Phillips JC. Predictive value of upper gastrointestinal studies versus clinical signs for gastrointestinal leaks after laparoscopic gastric bypass. Surg Endosc. 2007;21:194–6. Scholar
  6. 6.
    Yu J, Turner MA, Cho S-R, Fulcher AS, DeMaria EJ, Kellum JM, et al. Normal anatomy and complications after gastric bypass surgery: helical CT findings. Radiology. 2004;231:753–60. Scholar
  7. 7.
    Lyass S, Khalili TM, Cunneen S, Fujita F, Otsuka K, Chopra R, et al. Radiological studies after laparoscopic Roux-en-Y gastric bypass: routine or selective? Am Surg. 2004;70:918–21.PubMedGoogle Scholar
  8. 8.
    White S, Han SH, Lewis C, Patel K, McEvoy B, Kadell B, et al. Selective approach to use of upper gastroesophageal imaging study after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4:122–5. Scholar
  9. 9.
    Sethi M, Zagzag J, Patel K, Magrath M, Somoza E, Parikh MS, et al. Intraoperative leak testing has no correlation with leak after laparoscopic sleeve gastrectomy. Surg Endosc. 2015;30:883. Scholar
  10. 10.
    Nelson L, Moon RC, Teixeira AF, Jawad MA. Methylene blue or upper GI, which is more effective for detecting leaks in gastric bypass patients? Surg Laparosc Endosc Percutan Tech. 2015;25:451–4. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Amador García Ruiz de Gordejuela
    • 1
  • Jordi Pujol Gebelli
    • 1
  1. 1.Bariatric Surgery Unit, General Surgery DepartmentBellvitge University HospitalBarcelonaSpain

Personalised recommendations