The role of flexible endoscopy in laparoscopic Roux-en-Y gastric bypass

Background the intraoperative flexible endoscopy is recently gaining popularity as an additional tool to increase the safety in gastrointestinal (GI) surgery; however, its role in bariatric surgery is currently not known. The aim of the study was to evaluate the effectiveness of the routine use of flexible endoscopy (FE) as an added tool to increase safety in laparoscopic Roux-en-Y gastric bypass (LGBP) for morbid obesity. Methods Since 1979, in our University Division of Surgery more than 10,000 patients underwent intraoperative FE at the time of GI surgery to exclude anasthomotic technical errors. We transferred this long-term experience with FE on laparoscopic bariatric procedures. Thus, an intraoperative endoscopy was accomplished at the end of LGBP to check the caliber of the gastro-jejunal anasthomosis and to exclude a leak by simultaneous endoscopic air insufflation and laparoscopic irrigation. Results Fifty-two consecutive patients underwent LGBP. Mean age was 42.1 years (range, 28–59); mean BMI was 52.2 (range, 41–72). Mean operative time was 160 min (range, 95–660). All of the five patients (9.6%) were converted to conventional surgery occurred during the first ten cases. Mortality was nil. A postoperative leak occurred in three patients (5.7%) during the first eight cases. This was located in all the cases at the gastro-jejunal anasthomosis. All these patient healed with a conservative approach, and in no cases reoperation was necessary. Conclusion The routine use of intraoperative FE helped to maintain low the postoperative leak rate. This tool seems to increase the safety of the operation during the learning curve.