Bougie-Induced Esophageal Perforation During Laparoscopic Roux-en-Y Gastric Bypass Surgery with Hiatus Hernia Repair.

Introduction: Use of bougie often helps in the calibration of gastric pouch and assess proper closure of the hiatus. Bougie induced esophageal perforation during surgery is uncommon. We encountered a case of bougie induced lower esophageal perforation while introducing it across a gastroesophageal junction.Here we discussed the cause, mechanism of perforation, and its management.

Material And Methods: A patient with BMI of 46.7 kg/m 2 was schedule for Laparoscopic Roux- en- Y Gastric Bypass with Hiatus Hernia Repair. A cruroplasty was performed using interrupted non-absorbable suture. Bougie intubation across gastroesophageal junction was unsuccessful after closure of hiatus. Possibilities of incorporation of a esophageal wall during cruroplasty or too tight hiatus was suspected. Crural approximation suture was removed and esophagus was inspected, which showed posterior perforation at the distal esophagus. Primary closure done with fullthickness interrupted 3'0 absorbable suture to create full-thickness interrupted stitches.A Jackson-Pratt drain was placed close to hiatus.

Result: We kept the patient nil per orally for two days.On the fourth postoperative day,the patient recovered uneventfully and was discharge after drain removal.

Conclusion: Bougie induced perforation is uncommon and occurs after improper manipulation of bougie across the gastroesophageal junction. Acute esophageal angulation and over thrusting of the bougie against closed hiatus can contribute to posterior esophageal perforation. Inspection of the esophagus above the hiatus is essential to avoid missed perforation.