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The utility of radiological upper gastrointestinal series and clinical indicators in detecting leaks after laparoscopic sleeve gastrectomy: a case-controlled study

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Abstract

Background

Leak after laparoscopic sleeve gastrectomy (LSG) often presents after hospital discharge, making timely diagnosis difficult. This study evaluates the utility of radiological upper gastrointestinal (UGI) series and clinical indicators in detecting leak after LSG.

Methods

A retrospective case-controlled study of 1762 patients who underwent LSG from 2006 to 2014 was performed. All patients with radiographically confirmed leaks were included. Controls consisted of patients who underwent LSG without leak, selected using a 10:1 case-match. Data included baseline patient characteristics, surgical characteristics, and UGI series results. Clinical indicators including vital signs, SIRS criteria, and pain score were compared between patients who developed leak and controls.

Results

Of 1762 LSG operations, 20 (1.1 %) patients developed leaks and were compared with 200 case-matched controls. Three patients developed leak during their index admission [mean = 1.3 days, range (1, 2)], while the majority (n = 17) were discharged and developed symptoms at a mean of 17.1 days [range (4, 63)] postoperatively. Patients diagnosed with leak were similar to controls in baseline and surgical characteristics. Contrast extravasation on routine postoperative UGI identified two patients with early leaks, but was negative in the remainder (89 %). Patients with both early and delayed leaks demonstrated significant clinical abnormalities at the time of leak presentation, prior to confirmatory radiographic study. In multiple regression analysis, independent clinical factors associated with leak included fever [OR 16.6, 95 % CI (4.04, 68.10), p < 0.0001], SIRS criteria [OR 7.0, 95 % CI (1.47, 33.26), p = 0.014], and pain score ≥9 [OR 19.1, 95 % CI (1.38, 263.87), p = 0.028].

Conclusions

Contrast extravasation on routine postoperative radiological UGI series may detect early leaks after LSG, but the vast majority of leaks demonstrate normal results and present 2–3 weeks after discharge. Therefore, clinical indicators (specifically fever, SIRS criteria, and pain score) are the most useful factors to raise concern for leaks prior to confirmatory radiographic study and may be used as criteria to selectively obtain UGI studies after LSG.

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Acknowledgments

The authors wish to acknowledge Heekoung Youn, MA, for technical assistance and G. Craig Wood, MS, for leading the statistical analyses sited in this publication.

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Authors and Affiliations

  1. Division of Bariatric Surgery, Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite 10S, New York, NY, 10016, USA

    Monica Sethi, Melissa Magrath, Eduardo Somoza, Manish Parikh, John Saunders, Aku Ude-Welcome, Bradley Schwack, Marina Kurian, George Fielding & Christine Ren-Fielding

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  1. Monica Sethi
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  2. Melissa Magrath
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  3. Eduardo Somoza
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  4. Manish Parikh
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  8. Marina Kurian
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Correspondence to Monica Sethi.

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Disclosures

Dr. Christine Ren-Fielding previously received research grants (S# 06-851, S#10686) and an honorarium as a speaker for Allergan Medical and is currently a consultant for Apollo Endosurgery. Dr. Fielding previously received an honorarium as part of the Speaker’s Bureau/Faculty, a research grant (S# 06-851, S#10686) and educational grant from Allergan Medical, and is currently on the Speaker’s Bureau for Apollo Endosurgery. Dr. Kurian received a research grant (S#06-851) and an honorarium as a speaker for Allergan Medical, an honorarium as a speaker for Apollo Endosurgery, and is currently on the faculty of Gore. Dr. Schwack received an honorarium as a speaker for Allergan Medical. Drs. Sethi, Magrath, Somoza, Parikh, Saunders, and Ude-Welcome have no conflicts of interest or financial ties to disclose.

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Sethi, M., Magrath, M., Somoza, E. et al. The utility of radiological upper gastrointestinal series and clinical indicators in detecting leaks after laparoscopic sleeve gastrectomy: a case-controlled study. Surg Endosc 30, 2266–2275 (2016). https://doi.org/10.1007/s00464-015-4516-z

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  • DOI: https://doi.org/10.1007/s00464-015-4516-z

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