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Johns Hopkins Pediatric

Bariatric Surgery Case Study – Gastric Bypass with ICG Leak Test

Johns Hopkins Center for Bariatric Surgery, National Capital Region

Patient presentation

  • A 38-year-old female with a history of class 3 obesity (BMI 45.9), gastroesophageal reflux disease (GERD), hypertension and sleep apnea presented with multiple failed attempts at medical weight-loss. She was initially interested in a minimally invasive sleeve gastrectomy, but a gastric bypass was recommended due to her history of GERD. A sleeve gastrectomy can worsen heartburn postoperatively, but a gastric bypass is a surgical treatment for both morbid obesity as well as GERD. The patient was evaluated by the bariatric multidisciplinary team at Sibley Memorial Hospital and approved for surgery.


Treatments received

  • The patient underwent a minimally invasive Roux-en-Y gastric bypass using the latest camera technology. After her procedure, a new technique was used to test the gastro-jejunal anastomosis for any signs of a leak. A novel fluid solution containing indocyanine green dye was instilled into the stomach, and a laparoscopic camera with near-infrared fluorescence visualization was used to transilluminate the anastomosis. It gave real-time feedback and confirmed no leak was present.


 Patient outcome after surgery

  • The patient was kept overnight and discharged the following day after passing an oral fluid challenge. She was seen two weeks later and was feeling well, tolerating a soft diet and already beginning to see weight loss results.


Johns Hopkins Center for Bariatric Surgery at Sibley Memorial Hospital in Washington, D.C., is accredited from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) as a Comprehensive Center with Adult Qualifications. The team performs open and minimally invasive surgery using state-of-the art equipment. In addition to surgery, the multidisciplinary team provides nutrition counseling, exercise training and close follow-up after surgery. 


Image 1: Before the indocyanine green leak test, showing the laparoscopic grasping occluding the alimentary limb of the small bowel.



Image 2: New fluorescent video imaging demonstrates the contrast has passed through the stomach and into the small bowel, with no leaking of contrast into the abdominal cavity.




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