Skip to main content
SpringerLink
Log in

Intérêt pronostique du dosage de la procalcitonine pour la prédiction du risque de fistule post gastrectomie par manchon type Sleeve chez des patients obèses

Pronostic impact of dosage of procalcitonin to predict fistula’s risk after Sleeve gastrectomy

  • Cas Clinique / Case Report
  • Published:
Obésité

Résumé

Introduction

L’obésité est un problème épidémiologique majeur de nos sociétés actuelles. La Sleeve gastrectomie est une des techniques chirurgicales restrictives de l’obésité morbide, avec un risque de fistule de 2,4 % dans la littérature. Aucun paramètre clinique ou biologique ne permet à l’heure actuelle de prédire la survenue d’une fistule. La procalcitonine est un marqueur préditif de la survenue d’infection post opératoire.

Matériel et Méthodes

Une étude monocentrique prospective a été réalisée au Centre Hospitalier Intercommunal du Bassin de Thau. Ont été recueillis la tachycardie, la leucocytose, les valeurs de CRP et de procalcitonine à J3 et J5.

Résultats

Nous avons inclus 105 patients consécutifs. Deux ont présenté une fistule (1,9 %), 4 une reprise pour hémorragie (3,8 %). Les valeurs prédictives positives de l’hyperleucocytose, de la tachycardie, de la CRP à J3 étaient respectivement de 15,3 %, 5 %, 11,1 %. Les valeurs prédictives négatives de ces mêmes données à J3 étaient de 100 %, 100 % et 100 %. À J5, les valeurs prédictives positives de l’hyperleucocytose, de la tachycardie, de la CRP étaient respectivement de 20 %, 12,5 %, 8 %. Les valeurs prédictives négatives de ces mêmes données à J5 étaient de 100 %, 98,9 % et 100 %. La valeur prédictive positive de la procalcitonine à J3 et J5 était de 100 %, tout comme la valeur prédictive négative.

Conclusion

La procalcitonine semble un marqueur intéressant pour prédire la survenue de fistule après Sleeve gastrectomie. Ces résultats sont à confirmer par des études sur des populations de plus grand effectif. Les 2 fistules sont survenues chez des patients qui avaient été opérés d’un anneau gastrique, retiré par la suite.

Abstract

Introduction

Obesity is an epidemiologic major disease of our modern societies. Sleeve gastrectomy is one of the main procedures of baritatric surgery. Staple line fistula is the main risk of complications after Sleeve gastrectomy. No clinical or biological data can predict appearance of fistula. Dosage of procalcitonin is a very sensible and specific marker of post operative sepsis.

Methods

A monocentric and prospective study was performed in Centre Hospitalier Intercommunal du Bassin de Thau. We studied tachycardia, white blood cells counts, CRP and procalcitonin at D3 and D5.

Results

We included 105 consecutive patients. Two of them developed a fistula (1.9%), 4 of them a bleeding (3.8%). Positives predictives values of hyperleucocytosis, tachycardia, CRP levels at D3 were respectively 15.3%, 5%, 11.1%. Negatives predictives values of those datas were 100%, 100% and 100%. At D5, positives predictives values of hyperleucocytosis, tachycardia, CRP levels were respectively 20%, 12.5%, 8%. Negatives predicitves values of those datas were 100%, 98.9%, and 100%. Positive predictive value of procalcitonin at D3 and D5 were 100%, as well as negative predictive value.

Conclusion

Procalcitonin is a very interesting marker to predict fistula after Sleeve gastrectomy. These results need to be validated by larger studies. The 2 fistulas arose in patients who had a lap band removed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Références

  1. Maggard Ma, Shugarman LR, Suttorp M, et al Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–559

    Article  PubMed  Google Scholar 

  2. Moon HS, Kim WW, Oh JH. Reults of laparoscopic sleeve gastrectomy (LSG) et 1 year in morbidly obese Korean patients. Obes Surg. 2005;15:1469–1475

    Article  Google Scholar 

  3. Rosenthal RJ; International Sleeve Gastrectomy Expert Panel, Diaz AA, Arvidsson D, Baker RS, Basso N, Bellanger D, Boza C, El Mourad H, France M, Gagner M, Galvao-Neto M, Higa KD, Himpens J, Hutchinson CM, Jacobs M, Jorgensen JO, Jossart G, Lakdawala M, Nguyen NT, Nocca D, Prager G, Pomp A, Ramos AC, Rosenthal RJ, Shah S, Vix M, Wittgrove A, Zundel N. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012 Jan–Feb;8(1):8–19. doi: 10.1016/j.soard.2011.10.019. Epub 2011 Nov 10

    Article  PubMed  Google Scholar 

  4. Noel P, Iannelli A, Sejor E, Schneck AS, Gugenheim J. Laparoscopic Sleeve gastrectomy: how I do it? Surg Laparosc Endosc Percutan Tech. 2013 Feb;23(1):e14–e16. doi: 10.1097/SLE.0b013e318274b8cf.

    Article  PubMed  Google Scholar 

  5. Fuks D, Verhaeghe P, Brehant O, Sabbagh C, Dumont F, Riboulot M, Delcenserie R, Regimbeau JM Results oflaparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery 2009 Jan; 145(1): 106–113. Doi 10.1016/j.surg.2008.07.013.Epub 2008 Sep 30

    Article  PubMed  Google Scholar 

  6. Albanopoulos K, Alevizos L, Natoudi M, Dardamanis D, Menenakos E, Stamou K, Zografos G, Leandros E. C-reactive protein, white blood cells, and neutrophils as early predictors of postoperative complications in patients undergoing laparoscopic sleeve gastrectomy. Surg Endosc. 2013 Mar;27(3):864–871. doi: 10.1007/s00464-012-2526-7. Epub 2012 Oct 6

    Article  PubMed  Google Scholar 

  7. Reith HB, Mittelkötter U, Debus ES, Küssner C, Thiede A. Procalcitonin in early detection of postoperative complications. Dig Surg. 1998;15(3):260–265

    Article  CAS  PubMed  Google Scholar 

  8. Rau B, Krüger CM, Schilling MK. Procalcitonin: improved biochemical severity stratification and postoperative monitoring in severe abdominal inflammation and sepsis. Langenbecks Arch Surg. 2004 Apr;389(2):134–144. Epub 2004 Mar 6

    Article  CAS  PubMed  Google Scholar 

  9. Ito S, Sato N, Kojika M, Yaegashi Y, Suzuki Y, Suzuki K, Endo S Serum procalcitonin levels are elevated in esophageal cancer patients with postoperative infectious complications. Eur Surg Res. 2005 Jan–Feb;37(1):22–28

    Article  CAS  PubMed  Google Scholar 

  10. Oberhofer D, Juras J, Pavicić AM, Rancić Zurić I, Rumenjak V. Comparison of C-reactive protein and procalcitonin as predictors of postoperative infectious complications after elective colorectal surgery. Croat Med J. 2012 Dec;53(6):612–619

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Moszkowicz D, Arienzo R, Khettab I, Rahmi G, Zinzindohoué F, Berger A, Chevallier JM. Sleeve gastrectomy severe complications: is it always a reasonable surgical option? Obes Surg. 2013 May;23(5):676–686. doi: 10.1007/s11695-012-0860-4

    Article  PubMed  Google Scholar 

  12. Farrell TM, Haggerty SP, Overby DW, et al Clinical application of laparoscopic bariatric surgery: an evidence-based review. Surg Endosc. 2009;23:930–949

    Article  PubMed  Google Scholar 

  13. van Rutte PW, Smulders JF, de Zoete JP, Nienhuijs SW. Indications and short-term outcomes of revisional surgery after failed or complicated sleeve gastrectomy. Obes Surg. 2012 Dec;22(12):1903–1908. doi: 10.1007/s11695-012-0774-1

    Article  PubMed  Google Scholar 

  14. Shitrit AB, Magen A, Swartzs E, Chen B, Matveychuk A, Talker O, Shitrit D. Long-term Reflux-Related Symptoms After Bariatric Surgery: Comparison of Sleeve Gastrectomy Versus Laparoscopic Adjustable Gastric Banding. Lung. 2013 Mar 28

    Google Scholar 

  15. Krumsdorf U, Chorianopoulos E, Pleger ST, Kallenbach K, Karck M, Katus HA, Bekeredjian R C-reactive protein kinetics and its prognostic value after transfemoral aortic valve implantation. J Invasive Cardiol. 2012 Jun;24(6):282–286

    PubMed  Google Scholar 

  16. Theodorou VP, Papaioannou VE, Tripsianis GA, Panopoulou MK, Christophoridis EK, Kouliatsis GA, Gioka TM, Maltezos ES, Ktenidou-Kartali SI, Pneumatikos IA. Procalcitonin and procalcitonin kinetics for diagnosis and prognosis of intravascular catheter-related bloodstream infections in selected critically ill patients: a prospective observational study. BMC Infect Dis. 2012 Oct 8;12:247. doi: 10.1186/1471-2334-12-247

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hôpital Saint Clair, Centre Hospitaliser Intercommunal du Bassin de Thau, boulevard Camille Blanc, 34200, Sète, France

    J. Bertrand, I. Constant & C. Vacher

Authors
  1. J. Bertrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Constant
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Vacher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Bertrand.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bertrand, J., Constant, I. & Vacher, C. Intérêt pronostique du dosage de la procalcitonine pour la prédiction du risque de fistule post gastrectomie par manchon type Sleeve chez des patients obèses. Obes 8, 248–251 (2013). https://doi.org/10.1007/s11690-013-0393-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11690-013-0393-6

Mots clés

Keywords

Search

Navigation