Surgical Endoscopy

, Volume 31, Issue 12, pp 5283–5288 | Cite as

C-reactive protein, fibrinogen, and procalcitonin levels as early markers of staple line leak after laparoscopic sleeve gastrectomy in morbidly obese patients within an Enhanced Recovery After Surgery (ERAS) program

  • Jaime Ruiz-TovarEmail author
  • Jose Luis Muñoz
  • Juan Gonzalez
  • Alejandro Garcia
  • Carlos Ferrigni
  • Montiel Jimenez
  • Manuel Duran



The performance of most bariatric procedures within an Enhanced Recovery After Surgery program has resulted in significant advantages, including a reduction in the length of hospital stay to 2–3 days. However, some postoperative complications may appear after the patient has been discharged. The aim of this study was to investigate the efficacy of various acute-phase parameters determined 24 h after a laparoscopic sleeve gastrectomy for predicting staple line leak in the postoperative course.

Patients and methods

A prospective study of 208 morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between 2012 and 2015 was performed. Blood analysis was performed 24 h after surgery. Acute-phase parameters (C-reactive protein, procalcitonin, fibrinogen, and White Blood Cell count) were investigated.


Staple line leak appeared in eight patients (3.8%). Using receiver operating characteristic analysis at 24 h postoperatively, a cutoff level of CRP at 9 mg/dL achieved 85% sensitivity and 90% specificity for predicting staple line leak, a cutoff level of procalcitonin at 0.85 ng/mL achieved 70% sensitivity and 90% specificity, and a cutoff level of fibrinogen at 600 mg/dL achieved 80% sensitivity and 87.5% specificity.


An elevation of CRP > 9 mg/dL, procalcitonin > 0.85 ng/mL and fibrinogen > 600 mg/dL should alert the surgeon the possibility of occurrence of postoperative staple line leak.


Sleeve gastrectomy C-reactive protein Fibrinogen Markers of septic complications 


Compliance with ethical standards


Jaime Ruiz-Tovar, MD, PhD; Jose Luis Muñoz, MD, PhD; Juan Gonzalez, MD; Alejandro García, MD; Carlos Ferrigni, MD; Montiel Jimenez, MD; and Manuel Durán, MD, PhD, have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.University Hospital Rey Juan CarlosMóstolesSpain
  2. 2.Department of Anesthesia, Bariatric Surgery UnitGeneral University Hospital ElcheAlicanteSpain

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