Is a routine liquid contrast swallow following laparoscopic gastric banding mandatory?

Background: The authors assess the value of liquid contrast medium swallow as a method to detect postoperative complications after laparoscopic adjust able gastric banding (LAGB) for the treatment of morbid obesity. Methods: From January 1996 to January 2001, 350 morbidly obese patients (29 5 women, 55 men) underwent a LAGB operation. All data were prospectively co llected in a computerized databank. All patients underwent a jopomidol swal low (JS) study in the early postoperative phase to exclude perforation of t he esophagus or stomach, which is one of the most serious complications occ urring after the LAGB operation. Furthermore, the JS was performed to confi rm band position and to exclude early pouch dilatation. Results: Out of the 350 LAGB operations, 6(1.8%) early pouch dilatations an d 4(1.2%) stomach perforations occurred. All early pouch dilatations were r ecognized on postoperative JS and immediately repaired laparoscopically. Of the perforations, one was recognized intraoperatively, and the other three were diagnosed postoperatively, either by contrast media extravasation on the JS (two patients) or by computer tomography. Conclusion: Presently, all patients undergo routine postoperative JS, which exposes them to radiation, causes patient discomfort, and entails addition al costs of approximately 100 US$ per patient. Of the last 250 patients in our series, there have not been any cases of early pouch dilatation and sin ce 1998 only one case of perforation has occurred, which could be easily su spected clinically. Therefore, we believe that in experienced centers, it i s not necessary to perform routine postoperative contrast media studies and recommend JS only in cases of complicated postoperative courses.