OBES SURG DOI 10.1007/s11695-015-1682-y
LETTER TO THE EDITOR
A Simple Trick to Prevent VOMIT After Sleeve Gastrectomy Daniel Gero 1 & Lara Ribeiro-Parenti 1 & Jean-Pierre Marmuse 1
# Springer Science+Business Media New York 2015
Introduction
Discussion
Victim of medical imaging technologies (VOMIT) is a term coined by a pediatric neurosurgeon to describe anxiety-inducing false-positive results on radiologic imaging [1]. Morbidly obese patients have a low functional physiological reserve that constrains to a fast diagnostic work-up, and an aggressive and early treatment of potential complications [2]. Upper gastrointestinal contrast study (UGI) is a useful modality to detect functional and surgical complications after sleeve gastrectomy (SG) [3]. However, in some cases, the residual gastric tube is floppy, and the findings are hard to interpret. In this paper, we present a simple trick which aims to prevent SG patients from suffering physically as well as mentally and from undergoing unnecessary further diagnostic interventions due to a false-positive UGI finding.
Ideally, in SG patients, an UGI helps to rule out surgical (staple-line leak, abscess, twist of the gastric tube, mid-gastric stenosis) or functional (hiatal hernia, gastric
* Daniel Gero
[email protected] Lara Ribeiro-Parenti
[email protected] Jean-Pierre Marmuse
[email protected] 1
Department of General and Digestive Surgery, Bichat ClaudeBernard University Hospital, 46 Rue Henri Huchard, Paris 75018, France
Fig. 1 Early postoperative UGI of an asymptomatic sleeve gastrectomy patient without gastric tube fixation
OBES SURG
Fig. 2 Intraoperative image of the gastric tube fixation to the greater omentum
tube dilation, gastroesophageal reflux) complications. Occasionally, one might encounter UGIs showing the gastric tube in an unusual position (Fig. 1) which decreases the specificity of this radiologic exam and may contribute to an avoidable prolongated length of inpatient stay or further diagnostic work-up. In order to decrease the incidence of VOMIT, we introduced the fixation of the distal corner of the gastric tube to the greater omentum by a single resorbable stitch at the end of the laparoscopic SG procedure (Fig. 2). This simple trick was pilot-tested on fifteen consecutive SG patients in our tertiary bariatric referral center in February and March 2015. The trick did not add any pre- or postoperative morbidity, nor did significantly prolongate the operative time. The early postoperative UGIs showed a J-shaped gastric tube in all cases (Fig. 3), allowing a more comfortable interpretation, and thus, they reduced the concerns of the attending surgical team. The gastric fixation might also decrease the risk of organo-axial twists of the gastric tube. However, the impact of this trick on the prevention of gastric twists and on the quality of long-term postoperative UGIs remains to be defined. Conflict of Interest The authors declare that they have no conflict of interest. Ethical Approval All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. Informed Consent Informed consent was obtained from all individual participants included in the study.
References 1.
2.
3. Fig. 3 Early postoperative UGI of an asymptomatic sleeve gastrectomy patient with gastric tube fixation
McCoubrie P, Reid JH. Development of medical imaging technologies is the best way to advance clinical diagnostic accuracy and there is no such thing as VOMIT. J R Coll Physicians Edinb. 2012;42(4): 326–32. García-Ruiz-de-Gordejuela A, Madrazo-González Z, CasajoanaBadia A, et al. Evaluation of bariatric surgery patients at the emergency department of a tertiary referral hospital. Rev Esp Enferm Dig. 2015;107(1):23–8. Gnecchi M, Bella G, Pino AR, et al. Usefulness of x-ray in the detection of complications and side effects after laparoscopic sleeve gastrectomy. Obes Surg. 2013;23(4):456–9.