Palmar Staining Following Methylene Blue Leak Test During Laparoscopic Roux-en-Y Gastric Bypass

Background/Objectives: Anastomotic leakage remains the most devastating postoperative complication in colorectal surgery. The mechanical integrity of the newly formed colorectal anastomosis can be evaluated by visual inspection intraoperatively; both air leak and liquid leak tests are also used to evaluate the integrity of stapled colorectal anastomoses. It is not clear whether double-stapled anastomoses are more prone to leaks than single-stapled anastomoses. The aim of our study was to compare the methylene blue and the air leak test in the experimental setting of single-stapled and double-stapled porcine bowels. Methods: Twenty-four distal colons were excised from slaughtered pigs without delay. The proximal bowel end was closed with a linear stapler using blue cartridges. The bowels were randomly divided into single-stapled or double-stapled groups. Air leak and methylene blue leak tests were performed. A digital pressure monitor with a gradual pressure increase function was used to both gradually increase pressure within the bowel and to determine the pressure at which the stapler line disintegrated. Results: Air leakage occurred at a mean pressure of 51.62 (±16.60) mm Hg and methylene blue leakage occurred at 46.54 (±16.78) mm Hg (p = 0.31). The air and methylene blue leaks occurred at comparable pressures in single-stapled bowels and in double-stapled bowels (47.21 [±14.02] mm Hg vs. 50.96 [±19.15] mm Hg, p = 0.6). Conclusions: The methylene blue solution leak test is not inferior to the air leak test. There is no significant difference in bursting pressure between single-stapled and double-stapled anastomoses.

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Management of Surgical Complications after Gastric Bypass

10.1093/med/9780190608347.003.0028 ◽

2018 ◽

Author(s):

Amin Andalib ◽

Zhamak Khorgami ◽

Tomasz G. Rogula ◽

Philip R. Schauer

Keyword(s):

Gastric Bypass ◽

Anastomotic Leak ◽

Surgical Complications ◽

Anastomotic Stricture ◽

Gastric Pouch ◽

Surgical Techniques ◽

Common Site ◽

Leak Test ◽

Diagnosis And Management ◽

Circular Staplers

This chapter discusses the main issues with a selected group of surgical complications after Roux-en-Y gastric bypass. The main focus is on diagnosis and management of anastomotic leak and stricture, marginal ulcers, and gastrogastric fistulas. Anastomotic leak is one of the most feared and potentially catastrophic complications. The most common site is at gastrojejunostomy. Avoiding devascularization of the gastric pouch, creating a tension-free anastomosis, and performing an intraoperative anastomotic leak test are crucial technical points in preventing leaks. Once the leak is highly suspected or diagnosed, it needs to be managed swiftly. Different surgical techniques have different anastomotic stricture rates, with circular staplers being associated with the highest frequency of strictures at the gastrojejunostomy. Endoscopic dilatations are the mainstay of treatment.

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Methylene Blue or Upper GI, Which is More Effective for Detecting Leaks in Gastric Bypass Patients?

Surgical Laparoscopy Endoscopy & Percutaneous Techniques ◽

10.1097/sle.0000000000000191 ◽

2015 ◽

Vol 25 (5) ◽

pp. 451-454 ◽

Cited By ~ 4

Author(s):

Lars Nelson ◽

Rena C. Moon ◽

Andre F. Teixeira ◽

Muhammad A. Jawad

Keyword(s):

Methylene Blue ◽

Gastric Bypass ◽

Upper Gi

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Intraoperative Endoscopy and Leaks after Laparoscopic Roux-en-Y Gastric Bypass

The American Surgeon ◽

10.1177/000313480907500606 ◽

2009 ◽

Vol 75 (6) ◽

pp. 485-488 ◽

Cited By ~ 11

Author(s):

Diya Alaedeen ◽

Atul K. Madan ◽

Charles Y. Ro ◽

Khurram A. Khan ◽

Jose M. Martinez ◽

...

Keyword(s):

Methylene Blue ◽

Gastric Bypass ◽

Mortality Rate ◽

Leak Rate ◽

Intraoperative Endoscopy ◽

Sensitive Test ◽

Orogastric Tube ◽

Leak Testing ◽

Postoperative Leak ◽

The Difference

Postoperative leaks after laparoscopic Roux-en-Y gastric bypass (LRYGB) are a source of morbidity and mortality. Any intervention that would decrease leak rates after LRYGB would be useful. This investigation tested the hypothesis that postoperative leak rates are lower after LRYGB with the routine use of intraoperative endoscopy (EN). Consecutive patients who underwent LRYGB were included. Intraoperative leak testing with air and methylene blue through an orogastric tube (OG) was used in the first 200 patients. Intraoperative endoscopy was used after the first 200 patients. There were 400 patients in this study. Preoperative demographics did not differ between groups. The intraoperative leak rate of the EN group was double the OG group (8 vs 4%; P = not significant), although the difference was not statistically significant. The OG group had a postoperative leak rate of 4 per cent with a mortality rate of 1 per cent. The EN group had a postoperative leak rate of 0.5 per cent with a mortality rate of 0 per cent. The difference in leak rates was statistically significant ( P < 0.04). Despite the issues of learning curve, EN demonstrates more intraoperative leaks than OG, indicating EN may be a more sensitive test than OG. Routine use of EN is associated with less postoperative leaks after LRYGB.

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A SEM and Light Microscope Study of the Epidermal Leaf Structures of the Carnivorous Plant, Sarracenia purpurea, L.

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100065833 ◽

1971 ◽

Vol 29 ◽

pp. 358-359

Author(s):

B. J. Panessa ◽

J. F. Gennaro

Keyword(s):

Methylene Blue ◽

Toluidine Blue ◽

Outer Surface ◽

Microscope Study ◽

Light Microscope ◽

Carnivorous Plant ◽

Sarracenia Purpurea ◽

Inner Surface

Tissue from the hood and sarcophagus regions were fixed in 6% glutaraldehyde in 1 M.cacodylate buffer and washed in buffer. Tissue for SEM was partially dried, attached to aluminium targets with silver conducting paint, carbon-gold coated(100-500Å), and examined in a Kent Cambridge Stereoscan S4. Tissue for the light microscope was post fixed in 1% aqueous OsO4, dehydrated in acetone (4°C), embedded in Epon 812 and sectioned at ½u on a Sorvall MT 2 ultramicrotome. Cross and longitudinal sections were cut and stained with PAS, 0.5% toluidine blue and 1% azure II-methylene blue. Measurements were made from both SEM and Light micrographs.The tissue had two structurally distinct surfaces, an outer surface with small (225-500 µ) pubescent hairs (12/mm2), numerous stoma (77/mm2), and nectar glands(8/mm2); and an inner surface with large (784-1000 µ)stiff hairs(4/mm2), fewer stoma (46/mm2) and larger, more complex glands(16/mm2), presumably of a digestive nature.

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Selective Corrosion of brazed joint between BNi-2 filler metal and stainless steel 316

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100163551 ◽

1996 ◽

Vol 54 ◽

pp. 218-219

Author(s):

H. S. Kim ◽

R. U. Lee

Keyword(s):

Stainless Steel ◽

Filler Metal ◽

Surface Preparation ◽

Optical Microscope ◽

Heating Element ◽

Incomplete Fusion ◽

Atmospheric Conditions ◽

Leak Test ◽

High Temperature Side ◽

Inconel 600

A heating element/electrical conduit assembly used in the Orbiter Maneuvering System failed a leak test during a routine refurbishment inspection. The conduit, approximately 100 mm in length and 12 mm in diameter, was fabricated from two tubes and braze-joined with a sleeve. The tube on the high temperature side (heating element side) and the sleeve were made of Inconel 600 and the other tube was stainless steel (SS) 316. For the filler metal, a Ni-Cr-B brazing alloy per AWS BNi-2, was used. A Helium leak test spotted the leak located at the joint between the sleeve and SS 316 tubing. This joint was dissected, mounted in a plastic mold, polished, and examined with an optical microscope. Debonding of the brazed surfaces was noticed, more pronounced toward the sleeve end which was exposed to uncontrolled atmospheric conditions intermittently. Initially, lack of wetting was suspected, presumably caused by inadequate surface preparation or incomplete fusion of the filler metal. However, this postulation was later discarded based upon the following observations: (1) The angle of wetting between the fillet and tube was small, an indication of adequate wetting, (2) the fillet did not exhibit a globular microstructure which would be an indication of insufficient melting of the filler metal, and (3) debonding was intermittent toward the midsection of the sleeve.

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