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Routine Early Computed Tomography Scanner After Laparoscopic Sleeve Gastrectomy in High-Risk Severely Obese Patients Is Effective for Bleeding or Hematoma Diagnosis but not for Staple-Line Leak Detection: a Prospective Study

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Abstract

Purpose

Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric procedure worldwide. Postoperative staple-line leak and intraabdominal hemorrhage can increase associated morbidity and mortality. The value of routine early computed tomography (CT) scanner examination in the early diagnosis of complications in high-risk severely obese patients undergoing LSG is studied.

Methods

This was a prospective, non-randomized study including all patients undergoing LSG in our department from 2014 to 2020. Patients presenting at least one potential risk factor for postoperative gastric leak and bleeding (as defined by the current literature) were included. Primary endpoint was the efficacy of postoperative day (POD) 2 CT-scanner examination in diagnosing these complications.

Results

One thousand fifty-one high-risk patients were included. Median age was 44 years. Early postoperative surgical complications occurred in 48 patients (4.5%): 25 (2.3%) intraabdominal hemorrhage and 23 (2.2%) staple-line leak. Early CT-scanner detected intraabdominal bleeding or hematoma in 22/25 patients, with 95.6% sensitivity (Youden’s index = 0.95), while specificity was 100%, positive predictive value (PPV) 100%, and negative predictive value (NPV) 99.9%. Sensitivity of early postoperative CT-scanner was 43.4% (10/23 patients; Youden’s index = 0.43) for staple-line leak detection, with specificity of 100%, PPV 100%, and NPV 98.7%.

Conclusion

POD 2 CT-scanner in high-risk severely obese patients undergoing LSG is an excellent tool for early diagnosis of intraabdominal hemorrhage, but sensitivity remains low for staple-line leak detection. Close postoperative clinical follow-up of these patients is essential and any suspicion of postoperative surgical complication should motivate the performance of a CT-scanner.

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Authors and Affiliations

  1. Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, AP-HP, F-92140, Clamart, France

    Panagiotis Lainas, Evangelia Triantafyllou & Ibrahim Dagher

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

    Panagiotis Lainas, Pierre Chagué, Sophie Maitre, Laurence Rocher & Ibrahim Dagher

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

    Pierre Chagué, Sophie Maitre & Laurence Rocher

  4. Department of General Surgery, ASST Nord, Milan, Italy

    Carmelisa Dammaro

Authors
  1. Panagiotis Lainas
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  2. Evangelia Triantafyllou
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  3. Pierre Chagué
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  4. Carmelisa Dammaro
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  5. Sophie Maitre
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  6. Laurence Rocher
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  7. Ibrahim Dagher
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Corresponding author

Correspondence to Panagiotis Lainas.

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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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Key points

• Primary end-point: efficacy of postoperative day (POD) 2 CT-scanner in diagnosis of postoperative surgical complications in high-risk severely obese patients undergoing LSG.

• POD 2 CT scanner sensitivity of 95.6% for intraabdominal bleeding or hematoma detection.

• POD 2 CT scanner sensitivity of 43.4% for staple-line leak detection.

• POD 2 CT-scanner in high-risk severely obese patients undergoing LSG is an excellent tool for early diagnosis of intraabdominal hemorrhage, but sensitivity remains low for staple-line leak detection.

• Close postoperative clinical follow-up of these patients is essential.

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Lainas, P., Triantafyllou, E., Chagué, P. et al. Routine Early Computed Tomography Scanner After Laparoscopic Sleeve Gastrectomy in High-Risk Severely Obese Patients Is Effective for Bleeding or Hematoma Diagnosis but not for Staple-Line Leak Detection: a Prospective Study. OBES SURG 32, 1624–1630 (2022). https://doi.org/10.1007/s11695-022-05997-y

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  • DOI: https://doi.org/10.1007/s11695-022-05997-y

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