Air Leak Test: Extending the Horizon From the Bowel to Pancreatoduodenectomy

Background Intraoperative air leak test (ALT) is routinely used to check anastomosis of the stomach, small intestine, and rectum. Its advantage is that it repairs the leak at the same time, thus preventing postoperative complications and re-exploration. Method ALT was done by insufflating the stomach with air to check the integrity of gastrojejunal anastomoses (GJ); the same air was pushed into the afferent jejunal limb to distend it up to hepaticojejunostomy (HJ) and pancreaticojejunostomy (PJ), thus testing the leak at all three anastomoses. ALT was performed in 16 patients (group 1) and the results were compared with 52 patients (group 2) who underwent pancreatoduodenectomy (PD) without ALT, between August 2019 and December 2022. Results ALT revealed a GJ leak in two and an HJ leak in one out of 16 patients, all of which were repaired immediately. It did not reveal any PJ leak. No postoperative bile leak was seen in group 1, while postoperative bile leak was seen in five of 52 patients in group 2 on postoperative day (POD) 1. High drain fluid amylase in the left drain on POD 3 was present in 11 patients (69%) in group 1 and 30 patients (44%) in group 2. A right drain was removed two days earlier and a left drain one day earlier in group 1. Reintervention and 30-day mortality were higher in group 2. Hospital stay was shorter (7.4 versus 8.2 days) in group 1. Conclusion Intraoperative ALT identified an anastomotic leak from GJ and HJ but not PJ, facilitating its immediate repair, thus preventing serious postoperative complications following PD. Whether ALT has any role in the detection of a PJ leak needs further validation.