Clinical Efficacy of Jejunojejunostomy Leak Test Using Methylene Blue During Laparoscopic Roux-en-Y Gastric Bypass on Post-Operative Leak Rate

2018 ◽  
Vol 6 (2-3) ◽  
Author(s):  
Masood Amini ◽  
Mohammad Hassan Hashemizadeh ◽  
Masood Sepehrimanesh ◽  
Seyedeh Leila Poorbaghi ◽  
Razieh Naseri Mojarrad ◽  
...  
2019 ◽  
Vol 29 (3) ◽  
pp. 949-952 ◽  
Author(s):  
Monika E. Hagen ◽  
John Diaper ◽  
Jonathan Douissard ◽  
Minoa K. Jung ◽  
Leo Buehler ◽  
...  

2009 ◽  
Vol 75 (6) ◽  
pp. 485-488 ◽  
Author(s):  
Diya Alaedeen ◽  
Atul K. Madan ◽  
Charles Y. Ro ◽  
Khurram A. Khan ◽  
Jose M. Martinez ◽  
...  

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.


2020 ◽  
pp. 1-9
Author(s):  
Marius Kryzauskas ◽  
Austeja Elzbieta Degutyte ◽  
Vilius Abeciunas ◽  
Beatrice Lukenaite ◽  
Eugenijus Jasiunas ◽  
...  

<b><i>Background/Objectives:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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 (<i>p</i> = 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, <i>p</i> = 0.6). <b><i>Conclusions:</i></b> 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.


Author(s):  
Amin Andalib ◽  
Zhamak Khorgami ◽  
Tomasz G. Rogula ◽  
Philip R. Schauer

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.


2006 ◽  
Vol 321-323 ◽  
pp. 1560-1563
Author(s):  
Yong Hyeon Shin ◽  
Seung Soo Hong ◽  
In Tae Lim ◽  
Kwang Hwa Chung

The Korea Research Institute of Standards and Sciences has developed and maintained leak standards systems, and has accumulated much data on leak standards that have been disseminated during calibration and testing services. We have found that the indicative value of a leak detector and a halogen leak detector varies a lot, depending on the conditions encountered during sniffer mode operation. Therefore, to measure the reliability of the leak rate or when performing a leak test, proper test conditions are necessary. In addition, we found that the reliability increased when we used a guide tube that could influence the flow of air.


Author(s):  
Hans Ashar ◽  
Eugene Imbro ◽  
David Terao

Appendix J of 10 CFR 50, “Primary Reactor Containment Leakage Testing for Water-Cooled Power Reactors,” sets the testing requirements for preoperational and periodic verification of the leak-tight integrity of the primary reactor containment, including systems and components which penetrate containment of light water-cooled power reactors, and establishes the acceptance criteria for such tests. The purposes of the tests are to assure that leakage through the primary reactor containment and systems and components penetrating primary containment would not exceed allowable leakage rate values as specified in the plants’ technical specifications. The current Appendix J requirements provide two options for performing the tests. Option A (fully deterministic) requires that after the preoperational leakage rate tests, a set of three integrated leak rate tests (ILRT — termed as Type A tests) shall be performed, at approximately equal intervals during each 10-year service period. Option B does not provide a quantitative requirement for scheduling the periodic Type A tests. However, NEI 94-01, “Industry Guideline for Implementing Performance-Based Option of 10 CFR Part 50, Appendix J,” and NRC Regulatory Guide (RG). The containment is a vital engineering safety feature of a nuclear power plant. It encloses the entire reactor and reactor coolant system and serves as a final barrier against the release of radioactive fission products to the environment under various accident conditions. Containment design is based on pressure and temperature loadings associated with a loss-of-coolant-accident resulting from a double-ended rupture of the largest pipe in the reactor coolant system. Recently, it has been reported that in certain 1.163, “Performance-Based Containment Leak Test Program,” provide guidelines for determining the frequencies of preoperational and periodic leak rate tests using a performance based approach. The Option B requirements and NEI 94-01 guidance are based on NUREG-1493, “Performance Based Containment Leak-Test Program.” Based on the information provided by the operating data and their risk significance, the study calculated the change in risk (in person-rem) to public for the 15 alternatives considered in the study. However, recognizing the non-sensitivity of risk to change in Type A leak rate testing frequencies, as depicted in NUREG-1493, a number of licensees are proposing changes to their Type A test frequencies using NRC risk-informed guidance in RG 1.174, “An Approach for Using Probabilistic Risk Assessment in Risk-Informed Decisions on Plant-Specific Changes to the Licensing Basis.” The paper discusses certain key deterministic aspects of the risk-informed decision for the plant-specific changes in the ILRT frequencies.


2006 ◽  
Vol 326-328 ◽  
pp. 661-664 ◽  
Author(s):  
Sang Guk Lee ◽  
Jong Hyuck Park ◽  
Keun Bae Yoo ◽  
Sun Ki Lee ◽  
Sung Yull Hong

This study is to estimate the feasibility of acoustic emission(AE) method for the internal leak from the valves. In this study, two types of valve(a 4 inch glove steam valve and 4 inch ball water valve) leak tests using three different leak path and various leak rates were performed in order to analyze AE properties when leaks arise in valve seat. As a result of leak test for specimens simulated valve seat, we conformed that leak sound amplitude increased in proportion to the increase of leak rate, and leak rates were plotted versus peak acoustic amplitudes recorded within those two narrow frequency bands on each spectrum plot. The resulting plots of leak rate versus peak AE amplitude were the primary basis for determining the feasibility of quantifying leak acoustically. The large amount of data attained also allowed a favorable investigation of the effects of different leak paths, leak rates, pressure differentials and AE sensors on the AE amplitude spectrum. From the experimental results, it was suggested that the AE method for monitoring of leak was feasible.


2015 ◽  
Vol 25 (5) ◽  
pp. 451-454 ◽  
Author(s):  
Lars Nelson ◽  
Rena C. Moon ◽  
Andre F. Teixeira ◽  
Muhammad A. Jawad

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