Sir,
Nowadays, bariatric surgery for morbid obesity is commonly done.[1] Laparoscopic sleeve gastrectomy is one of the restrictive procedures done to limit the patient's capacity for intake of food. During the procedure, a gastric drain tube is put through the oral cavity to guide the procedure. Since the procedure is done laparoscopically, gastric pouch created, is checked for leaks, if any, from the suture line.[2]
Normally, the peritoneal cavity is filled with water and the air is pushed through the gastric tube to see the presence of any leak. But there is disparity between the syringe hub and the inlet of gastric tube resulting in the excessive leakage of air pushed through the gastric tube. Generally, the peritoneal cavity around the stomach is filled with water and one has to repeatedly push the air through the gastric tube to confirm any leakage from sutured gastric remnant. To prevent this problem, we have devised a simple solution. The connector of size 4.5 endotracheal tube (ETT) is taken and its 22 mm female side (used as male end) fits tightly into the end of the gastric tube. The hub of 50 ml syringe fits snugly into the other end of the ETT connector [Figure 1]. Leak test carried out with this assembly prevents undue leakage into the surrounding and makes the test smoother. Since we have started using this, both the surgeons and anesthetists are able to do the test easily and more authentically. To the best of our knowledge, this has not been documented in literature anywhere. We feel this is a simple solution for a critical step in bariatric surgery and should be used on regular basis.
Figure 1.
Gastric tube (a) ETT connector (b) and 50 ml syringe (c) assembly
REFERENCES
- 1.Roa PE, Kaidar-Person O, Pinto D, Cho M, Szomstein S, Rosenthal RJ. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: Technique and shortterm outcome. Obes Surg. 2006;16:1323–6. doi: 10.1381/096089206778663869. [DOI] [PubMed] [Google Scholar]
- 2.Márquez MF, Ayza MF, Lozano RB, Morales Mdel M, Díez JM, Poujoulet RB. Gastric leak after laparoscopic sleeve gastrectomy. Obes Surg. 2010;20:1306–11. doi: 10.1007/s11695-010-0219-7. [DOI] [PubMed] [Google Scholar]