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Computed Tomography Assessment of Fat Distribution and Staple-Line Leak Risk After Sleeve Gastrectomy

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Abstract

Purpose

Sleeve gastrectomy (SG) has become the most frequent bariatric procedure and staple-line leak represents its most feared complication. Visceral obesity, a core component of the metabolic syndrome, has been associated with worst postoperative outcomes after various abdominal surgical procedures, and can be estimated by computed tomography (CT). The aim of this study was to assess the impact of radiologically determined visceral obesity in the risk of staple-line leak after SG.

Material and Methods

A retrospective analysis of a prospective database was performed in consecutive patients undergoing SG. Several anthropometric variables were measured on a preoperative CT scan. Multivariate analysis was performed to determine preoperative risk factors for staple-line leak.

Results

During the study period, 377 patients were included in the analysis. The median BMI was 39.7 kg/m2 (36.5–43.5) and 8 patients (2.1%) presented a gastric leak. After multivariate analysis, visceral obesity defined by visceral fat area (VFA)/body surface area (BSA) ≥ 85 cm2/m2 was the only independent predictive factor for gastric leak (OR = 5312).

Conclusion

CT scan–assessed visceral obesity defined by a VFA/BSA ratio ≥ 85 cm2/m2 is associated with an increased risk of gastric leak after SG. Preoperatively radiological examination in patients suspected of visceral obesity would be useful to optimize preoperative management.

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Acknowledgments

The authors are grateful to Dr. George Rafek and the Department of Radiology, Antoine Béclère Hospital, for their support and help with the radiological analysis.

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Authors and Affiliations

  1. Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, 157 rue de la Porte de Trivaux, F-92141, Clamart, France

    Martin Gaillard, Antonio Esposito, Panagiotis Lainas, Pauline Cerbelaud, Ibrahim Dagher & Hadrien Tranchart

  2. Paris-Saclay University, F-91405, Orsay, France

    Martin Gaillard, Antonio Esposito, Panagiotis Lainas, Pauline Cerbelaud, Cosmin Sebastian Voican, Rodi Courie, Gabriel Perlemuter, Ibrahim Dagher & Hadrien Tranchart

  3. Department of Hepato-Gastroenterology and Nutrition, Antoine Béclère Hospital, AP-HP, F-92140, Clamart, France

    Cosmin Sebastian Voican, Rodi Courie & Gabriel Perlemuter

  4. Department of Radiology, Antoine Béclère Hospital, AP-HP, F-92140, Clamart, France

    Pierre Chague & Laurence Rocher

  5. BIOMAPS, IR4M, UMR8081, F-91401, Orsay, France

    Pierre Chague & Laurence Rocher

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  1. Martin Gaillard
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Corresponding author

Correspondence to Martin Gaillard.

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The authors declare that they have no conflict of interest.

Ethical Approval Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Gaillard, M., Esposito, A., Lainas, P. et al. Computed Tomography Assessment of Fat Distribution and Staple-Line Leak Risk After Sleeve Gastrectomy. OBES SURG 31, 2011–2018 (2021). https://doi.org/10.1007/s11695-020-05199-4

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  • DOI: https://doi.org/10.1007/s11695-020-05199-4

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