Drain amylase levels are an adjunct in detection of gastrojejunostomy leaks after Roux-en-Y gastric bypass

Journal of the American College of Surgeons
James W MaherJ M Kellum

Abstract

Because anastomotic leaks after gastric bypass surgery can have devastating consequences for the patient, early detection is highly desirable. This and many other bariatric surgical centers have discontinued routine use of upper gastrointestinal contrast x-ray because of the lack of cost-effectiveness, discomfort to the patient, and the failure of the study to detect some leaks. We postulated that drain amylase levels from a juxta-anastomotic drain would detect the presence of salivary amylase and be a sensitive test for gastrojejunostomy leak. Routine measurement of amylase levels from a drain adjacent to the gastrojejunostomy was instituted in 2005. Leak was defined as anastomotic incompetence documented either by confirmatory upper gastrointestinal contrast x-rays, CT scans, or reoperation. On postoperative day 1, the drain amylase levels of 350 patients were tested. Seventeen patients had postoperative leaks (4.8%); 14 of the 17 had leaks at the gastrojejunal anastomosis (82%). The median peak value for patients without leak was 79.5 IU/L+/-1,436.2 SD; for patients with leak it was 6,307 IU/L+/-50,166 (p < 0.0001, Wilcoxon rank sum test). All patients but one with a leak had a drain amylase > 400 IU/L. A drain amylase value...Continue Reading

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Citations

Jul 4, 2012·Surgical Endoscopy·Nasser SakranAhmad Assalia
Dec 21, 2013·Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery·Gadiel LisciaMarcello Lucchese
Oct 6, 2010·Advances in Surgery·Ashish Agarwala, John M Kellum
Aug 24, 2010·Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery·Shahzeer KarmaliDaniel W Birch
May 1, 2011·Asian Journal of Endoscopic Surgery·C C ChangJ C Chen
Sep 13, 2014·World Journal of Surgery·Mariëlle M E CoolsenCornelis H C Dejong
Oct 17, 2014·World Journal of Gastroenterology : WJG·Antoine Abou RachedHicham El Masri
Aug 21, 2015·World Journal of Gastroenterology : WJG·Gijs H K BerkelmansMisha D P Luyer
May 8, 2018·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Judith P M SchotsGrard A P Nieuwenhuijzen
Mar 22, 2018·Arquivos De Gastroenterologia·Igor Braga RibeiroEverton Cazzo
Sep 30, 2021·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·Alexander BullJames A Gossage
Aug 27, 2021·The Annals of Thoracic Surgery·Philip A LindenYaron Perry

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