IBC Oxford University Poster Abstract 25 - Role of intraoperative oesophagogastroscopic guidance in minimizing laparoscopic bariatric surgery related morbidity

Abstract Background Postoperative staple line and gastro-jejunal anastomosis (GJA) leak is one of the most serious complications after LSG and LRYGB. GJA leak has reported frequencies of 0.3–5.1% with mortality ranging from 1.5 to 3%. Early postoperative bleeding and anastomotic stricture are also significant complications in patients after LRYGB with reported frequencies of 3.4% to 11.1%. The use of a leak test is a common practice in bariatric surgery. Some surgeons advocate for an intra-operative endoscopy for their leak test, while others utilize air via a form of an oral gastric tube. Previous articles have demonstrated the value of endoscopy in surgical procedures and the low risk associated with its use. Objectives The current study will be conducted to assess the safety and efficacy of using endoscope that serves as the bougie tube and then it is already in place for early detection of complications for example leakage (positive air leak test),maladjustment of lumen size (sleeve or stoma) and bleeding. Methods Between September 2021 and August 2023, 100 laparoscopic bariatric surgery were performed. For sleeve gastrectomy, endoscope was used as Bougie tube then staple line will be checked, a positive air leak test was done. For bypass surgery, the stoma was entered by the endoscope for checking staples, patency and early detection and dealing with leakage and bleeding. Results Concerning intraoperative complications, no patient had bleeding. two patients had leak which was corrected by reinforcement suture. Another patient had twisting which was corrected. Postoperatively, all patients did not develop leak, bleeding or obstructive symptoms. Three patients had postoperative vomiting which was corrected by prescribing antiemetics. There were no statistically significant associations between incidence of intra/postoperative complications and either age, weight, body mass index, operative time or comorbidities. Conclusion Overall, our experience has been very positive with utilization of intraoperative endoscopy after creation of our sleeve gastrectomy. Our leak rate is extremely low and occurred very early in our experience, and we believe that taking the extra time to perform a leak test using an endoscope will pay dividends for both the practitioner and the patient.