Dyed solution test or air pressure test?
Gastric air pressure testing can detect even a very small leakage during surgery.
During sleeve gastrectomy surgery it is common practice to perform leakage testing with instillation of a dyed solution in to the stomach through the calibration tube. If a small leakage is present, it could be hard to see with this method and yield a false negative result.
Like any bariatric procedure, the sleeve gastrectomy can have serious complications: leakage of the staple line is the most common and can occur along any segment of the stapled stomach. Most series in medical literature report ˂1% leakage rate. This is a treatable problem and rarely leads to mortality if treated correctly1.
A different approach for leakage testing is performed at OCC. After gastric stapling and over suturing the staple line are completed, the calibration tube or bougie is pulled out to the gastric inlet (also known as the cardias). The gastric outlet is clamped and the complete stomach is submerged under a liquid solution (Saline 0.9% solution) irrigated into the abdominal cavity, while the patients position is changed, so that the upper abdomen can be filled with the solution. The submerged stomach is insufflated with air under certain pressure, making the test very sensitive for the detection of even the smallest leak during surgery. After this, the liquid is aspirated from the abdominal cavity. Many of our patients have pointed out similarities of this test to “checking for a flat tire”. The testing takes approximately 3 to 4 minutes to complete.
Our philosophy and goal is prevention. The type of air pressure testing described earlier, is performed routinely on every patient submitted for sleeve gastrectomy surgery at OCC, regardless of being a primary or revision procedure. This gives the surgeon a unique opportunity to detect any potential staple line leakage and reinforce and/or repair any area that is actively leaking air. Not all surgeons test for leakage after sleeve gastrectomy. In an international expert panel consensus study for sleeve gastrectomy surgery only 48% recommended routine leakage testing 1.
At OCC, we have performed hundreds of gastric sleeve surgeries without leakage (0%). Our philosophy and goal is that of prevention and awareness. Prevention starts with good preoperative nutrition and weight loss, as well as optimal control of any underlining illnesses. During the surgical procedure, a high level of expertise meticulous surgical dissection of the areas that are going to be stapled and a perfect staple line placement, are key for leakage prevention. The over suturing of the staple line reinforces and creates a double seal for the greater curvature of the stomach adding safety. No less important, the air pressure test gives reassurance that the surgical technique was perfectly executed.
1 International Sleeve Gastrectomy Expert Panel Concensus Statement: best practice guidelines based on expirience of ˃12,000 cases. R. Rosenthal, Surgery for Obesity and Related Diseases 8 (2012) 8-19