Obesity Surgery

, Volume 28, Issue 8, pp 2379–2385 | Cite as

Preoperative Detection of Sarcopenic Obesity Helps to Predict the Occurrence of Gastric Leak After Sleeve Gastrectomy

  • Martin Gaillard
  • Hadrien TranchartEmail author
  • Sophie Maitre
  • Gabriel Perlemuter
  • Panagiotis Lainas
  • Ibrahim Dagher
Original Contributions



Sleeve gastrectomy (SG) has become the primary procedure for many bariatric teams and staple-line leak represents its most feared complication. Sarcopenic obesity combines the risks of obesity and depleted lean mass leading possibly to an inferior surgical outcome after abdominal surgery.


The aim of this study was to evaluate the existence of a potential link between radiologically determined sarcopenic obesity and staple-line leak risk after SG.


A retrospective analysis of a prospective database was performed in consecutive patients undergoing SG as primary procedure. Total psoas muscles (TPA) and total visible muscles (TMA) areas were measured on a preoperative computed tomography (CT). Sarcopenia was defined as lowest tertile of skeletal muscular mass indexes (muscular areas over square of height) in each gender (using TPA or TMA). Multivariate analysis was performed to determine preoperative risk factors for staple-line leak.


During the study period, 205 patients were included in the analysis. Median BMI was 40.8 kg/m2 (34.2–49.6), and 9 patients (4.4%) presented a gastric leak. The sex-specific cut-offs for skeletal muscular mass index according to TPA were 8.2 cm2/m2 for men and 6.08 cm2/m2 for women. After multivariate analysis, preoperative weight (OR = 1043) and sarcopenia (TPA) (OR = 5204) were independent predictive factors for gastric leak.


The present series suggests that CT scan-determined sarcopenic obesity is associated with increased risk of gastric leak after SG. This preoperatively radiological examination would be a useful clinical tool to tailor patient management according to gastric leak risk.


Sarcopenia Obesity Gastric leak Sleeve gastrectomy Tomodensitometry 


Compliance with Ethical Standards

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

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Deitel M, Gagner M, Erickson AL, et al. Third International Summit: current status of sleeve gastrectomy. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2011;7(6):749–59.CrossRefGoogle Scholar
  2. 2.
    Gaillard M, Tranchart H, Lainas P, et al. Single-port laparoscopic sleeve gastrectomy as a routine procedure in 1000 patients. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2016;12(7):1270–7.CrossRefGoogle Scholar
  3. 3.
    Livingston EH, Huerta S, Arthur D, et al. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg. 2002;236(5):576–82.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    O’Rourke RW, Andrus J, Diggs BS, et al. Perioperative morbidity associated with bariatric surgery: an academic center experience. Arch Surg. 2006;141(3):262–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Longitudinal Assessment of Bariatric Surgery C, Flum DR, Belle SH, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.CrossRefGoogle Scholar
  6. 6.
    Lagandre S, Arnalsteen L, Vallet B, et al. Predictive factors for rhabdomyolysis after bariatric surgery. Obes Surg. 2006 Oct;16(10):1365–70.CrossRefPubMedGoogle Scholar
  7. 7.
    Flancbaum L, Belsley S. Factors affecting morbidity and mortality of Roux-en-Y gastric bypass for clinically severe obesity: an analysis of 1,000 consecutive open cases by a single surgeon. J Gastrointest Surg : Off J Soc Surg Aliment Tract. 2007;11(4):500–7.CrossRefGoogle Scholar
  8. 8.
    van den Broek RJ, Buise MP, van Dielen FM, et al. Characteristics and outcome of patients admitted to the ICU following bariatric surgery. Obes Surg. 2009;19(5):560–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Inabnet 3rd WB, Belle SH, Bessler M, et al. Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2010;6(1):22–30.CrossRefGoogle Scholar
  10. 10.
    Benedix F, Poranzke O, Adolf D, et al. Staple line leak after primary sleeve gastrectomy-risk factors and mid-term results: do patients still benefit from the weight loss procedure? Obes Surg. 2017;27(7):1780–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Batsis JA, Mackenzie TA, Barre LK, et al. Sarcopenia, sarcopenic obesity and mortality in older adults: results from the National Health and Nutrition Examination Survey III. Eur J Clin Nutr. 2014;68(9):1001–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Jones K, Gordon-Weeks A, Coleman C, et al. Radiologically determined sarcopenia predicts morbidity and mortality following abdominal surgery: a systematic review and meta-analysis. World J Surg. 2017;41(9):2266–79.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Mei KL, Batsis JA, Mills JB, et al. Sarcopenia and sarcopenic obesity: do they predict inferior oncologic outcomes after gastrointestinal cancer surgery? Perioper Med. 2016;5:30.CrossRefGoogle Scholar
  14. 14.
    HAS. Obesite: prise en charge chirurgicale de l’adulte. Saint Denis (France): HAS edition. 2009:1–263. Epub HAS edition.Google Scholar
  15. 15.
    Voron T, Tselikas L, Pietrasz D, et al. Sarcopenia impacts on short- and long-term results of hepatectomy for hepatocellular carcinoma. Ann Surg. 2015;261(6):1173–83.CrossRefPubMedGoogle Scholar
  16. 16.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412–23.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Baumgartner RN, Koehler KM, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998;147(8):755–63.CrossRefPubMedGoogle Scholar
  19. 19.
    Park SH, Park JH, Song PS, et al. Sarcopenic obesity as an independent risk factor of hypertension. J Am Soc Hypertens: JASH. 2013;7(6):420–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Hong HC, Hwang SY, Choi HY, et al. Relationship between sarcopenia and nonalcoholic fatty liver disease: the Korean Sarcopenic Obesity Study. Hepatology. 2014;59(5):1772–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Batsis JA, Barre LK, Mackenzie TA, et al. Variation in the prevalence of sarcopenia and sarcopenic obesity in older adults associated with different research definitions: dual-energy X-ray absorptiometry data from the National Health and Nutrition Examination Survey 1999-2004. J Am Geriatr Soc. 2013;61(6):974–80.CrossRefPubMedGoogle Scholar
  22. 22.
    Batsis JA, Mackenzie TA, Jones JD, et al. Sarcopenia, sarcopenic obesity and inflammation: results from the 1999-2004 National Health and Nutrition Examination Survey. Clin Nutr. 2016;35(6):1472–83.CrossRefPubMedGoogle Scholar
  23. 23.
    Heber D, Ingles S, Ashley JM, et al. Clinical detection of sarcopenic obesity by bioelectrical impedance analysis. Am J Clin Nutr. 1996;64(3 Suppl):472S–7S.CrossRefPubMedGoogle Scholar
  24. 24.
    Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9(7):629–35.CrossRefPubMedGoogle Scholar
  25. 25.
    Yang YX, Chong MS, Lim WS, et al. Validity of estimating muscle and fat volume from a single MRI section in older adults with sarcopenia and sarcopenic obesity. Clin Radiol. 2017;72(5):427 e9–e14.CrossRefGoogle Scholar
  26. 26.
    Mitsiopoulos N, Baumgartner RN, Heymsfield SB, et al. Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol. 1998;85(1):115–22.CrossRefPubMedGoogle Scholar
  27. 27.
    Cunningham-Rundles S, McNeeley DF, Moon A. Mechanisms of nutrient modulation of the immune response. J Allergy Clin Immunol. 2005;115(6):1119–28. quiz 29CrossRefPubMedGoogle Scholar
  28. 28.
    Huang R, Gagner M. A thickness calibration device is needed to determine staple height and avoid leaks in laparoscopic sleeve gastrectomy. Obes Surg. 2015;25(12):2360–7.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Theodorakopoulos C, Jones J, Bannerman E, et al. Effectiveness of nutritional and exercise interventions to improve body composition and muscle strength or function in sarcopenic obese older adults: a systematic review. Nutr Res. 2017;43:3–15.CrossRefPubMedGoogle Scholar
  30. 30.
    Poggiogalle E, Migliaccio S, Lenzi A, et al. Treatment of body composition changes in obese and overweight older adults: insight into the phenotype of sarcopenic obesity. Endocrine. 2014;47(3):699–716.CrossRefPubMedGoogle Scholar
  31. 31.
    Molfino A, Amabile MI, Rossi Fanelli F, et al. Novel therapeutic options for cachexia and sarcopenia. Expert Opin Biol Ther. 2016;16(10):1239–44.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Minimally Invasive Digestive SurgeryAntoine Béclère Hospital, AP-HPClamartFrance
  2. 2.Paris-Sud UniversityOrsayFrance
  3. 3.Department of RadiologyAntoine Béclère Hospital, AP-HPClamartFrance
  4. 4.Department of Hepato-Gastroenterology and NutritionAntoine Béclère Hospital, AP-HPClamartFrance

Personalised recommendations