Skip to main content
SpringerLink
Log in

Is Routine Post-operative Biological Laboratory Assessment Necessary After Sleeve Gastrectomy?

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Incidence of post-operative complications after sleeve gastrectomy (SG) is low. However, the early identification of these complications remains crucial. Here, we report the impact of routine laboratory monitoring for the early diagnosis of complications after SG.

Material and Methods

From January 2018 to December 2019, all consecutive patients who underwent primary SG (n = 457) were included. This was a comparative study of patients undergoing primary SG. Patients were divided into two groups: one group with routine laboratory monitoring performed at postoperative day (POD) 1 and 3 (LAB group) and another group without routine laboratory monitoring (control group). The study’s primary endpoint was the overall impact of routine laboratory monitoring. The secondary endpoints were evaluation of patients with complications.

Results

The population in the two groups were similar in term of demographic and intra-operative data. There was a statistical difference between the two groups in term of length of stay (5.7 days in the LAB group and 3.5 days in the control group (p < 0.001)). There were 19 complications (6.0%) in the LAB group and 5 complications in the control group (3.5%) (p = 0.25). A cut-off C-reactive protein level of 46.3 mg/l was found to be significant (p = 0.006). In the LAB group, 9 patients (2.9%) required readmission vs. three patients (2.0%) in the control group (p = 0.62).

Conclusion

The interest of routine laboratory monitoring after SG seems limited. Routine laboratory monitoring alone is not associated with earlier diagnosis of complications. This routine monitoring is associated with an increase of stay in hospital.

Graphical Abstract

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

Fig. 1

Similar content being viewed by others

Data Availability

Data are available in our local registry.

References

  1. Robertson AGN, Wiggins T, Robertson FP, et al. Perioperative mortality in bariatric surgery: meta-analysis. Br J Surg. 2021;108:892–7.

    Article  CAS  PubMed  Google Scholar 

  2. Bennett WC, Garbarine IC, Mostellar M, et al. Comparison of early post-operative complications in primary and revisional laparoscopic sleeve gastrectomy, gastric bypass, and duodenal switch MBSAQIP-reported cases from 2015 to 2019. Surg Endosc. 2023;37:3728–38.

    Article  PubMed  Google Scholar 

  3. Berger ER, Clements RH, Morton JM, et al. The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies: the first report from the metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP). Ann Surg. 2016;264:464–73.

    Article  PubMed  Google Scholar 

  4. Stroh C, Köckerling F, Volker L, et al. Results of more than 11,800 sleeve gastrectomies: data analysis of the German bariatric surgery registry. Ann Surg. 2016;263:949–55.

    Article  PubMed  Google Scholar 

  5. De Angelis F, Abdelgawad M, Rizzello M, et al. Perioperative hemorrhagic complications after laparoscopic sleeve gastrectomy: four-year experience of a bariatric center of excellence. Surg Endosc. 2017;31:3547–51.

    Article  PubMed  Google Scholar 

  6. Al Zoubi M, Khidir N, Bashah M. Challenges in the diagnosis of leak after sleeve gastrectomy: clinical presentation, laboratory, and radiological findings. Obes Surg. 2021;31:612–6.

    Article  PubMed  Google Scholar 

  7. Sayida S, Obeid A, Jubran L, Mualem TY, Assalia A, Mahajna A. The relationship between tachycardia after laparoscopic sleeve gastrectomy and the development of postoperative complications. Obes Surg. 2022;32:1479–85.

  8. Rahman U, Docimo S, Pryor AD, et al. Routine contrast imaging after bariatric surgery and the effect on hospital length of stay. Surg Obes Relat Dis. 2018;14:517–20.

    Article  PubMed  Google Scholar 

  9. Lainas P, Tranchart H, Gaillard M, et al. Prospective evaluation of routine early computed tomography scanner in laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016;12:1483–90.

    Article  PubMed  Google Scholar 

  10. Lainas P, Tranchart H, Gaillard M, Ferretti S, Donatelli G, Dagher I. Prospective evaluation of routine early computed tomography scanner in laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016;12:1483–90.

  11. Lee Y, McKechnie T, Doumouras AG, et al.  Diagnostic Value of C-Reactive Protein Levels in Postoperative Infectious Complications After Bariatric Surgery: a Systematic Review and Meta-Analysis. Obes Surg. 2019; 29:2022–9.

  12. Williams M, Langlands F, Giles M. Does C-reactive protein day 1 post-surgery have a predictive role for post-operative complications: a single-centre perspective following published meta-analysis. Obes Surg. 2020;30:347–8.

    Article  PubMed  Google Scholar 

  13. Bona D, Micheletto G, Bonitta G, et al. Does C-reactive protein have a predictive role in the early diagnosis of postoperative complications after bariatric surgery? Systematic Review and Bayesian Meta-analysis. Obes Surg. 2019;29:3448–56.

    Article  PubMed  Google Scholar 

  14. Villard MA, Helm MC, Kindel TL, et al. C-Reactive protein as a predictor of post-operative complications in bariatric surgery patients. Surg Endosc. 2019;33:2479–84.

    Article  PubMed  Google Scholar 

  15. Rebibo L, Dhahri A, Badaoui R, Hubert V, Lorne E, Regimbeau JM. Laparoscopic sleeve gastrectomy as day-case surgery: a case-matched study. Surg Obes Relat Dis. 2019;15:534–45.

  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;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Csendes A, Burdiles P, Burgos AM, et al. Conservative management of anastomotic leaks after 557 open gastric bypasses. Obes Surg. 2005;15:1252–6.

    Article  PubMed  Google Scholar 

  18. Bruce J, Krukowski ZH, Al-Khairy G, et al. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg. 2001;88:1157–68.

    Article  CAS  PubMed  Google Scholar 

  19. Rebibo L, Hakim S, Dhahri A, et al. Gastric stenosis after laparoscopic sleeve gastrectomy: diagnosis and management. Obes Surg. 2016;26:995–1001.

    Article  PubMed  Google Scholar 

  20. Cosse C, Rebibo L, Brazier F, et al. Cost-effectiveness analysis of stent type in endoscopic treatment of gastric leak after laparoscopic sleeve gastrectomy. Br J Surg. 2018;105:570–7.

    Article  CAS  PubMed  Google Scholar 

  21. Romano L, Mattei A, Colozzi S, et al. Laparoscopic sleeve gastrectomy: a role of inflammatory markers in the early detection of gastric leak. J Minim Access Surg. 2021;17:342–50.

  22. Chivot C, Rebibo L, Robert B, et al. Value of routine upper gastrointestinal swallow study after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2017;13:758–65.

    Article  PubMed  Google Scholar 

  23. Rebibo L, Cosse C, Robert B, et al. Eliminating routine upper gastrointestinal contrast studies after sleeve gastrectomy decreases length of stay and hospitalization costs. Surg Obes Relat Dis. 2017;13:553–9.

    Article  PubMed  Google Scholar 

  24. Palumbo D, Socci C, Martinenghi C, et al. Leakage risk stratification after laparoscopic sleeve gastrectomy (LSG): is there a role for routine postoperative CT scan? Obes Surg. 2020;30:3370–7.

    Article  PubMed  Google Scholar 

  25. Dib F, Parenti LR, Boutten A, et al. Diagnostic performance of C-reactive protein in detecting post-operative infectious complications after laparoscopic sleeve gastrectomy. Obes Surg. 2017;27:3124–32.

    Article  PubMed  Google Scholar 

  26. Alqahtani AR, Elahmedi M, Amro N, et al. Laparoscopic sleeve gastrectomy as day-case surgery versus conventional hospitalization: results of the DAYSLEEVE randomized clinical trial. Surg Obes Relat Dis. 2022;18(9):1141–9. https://doi.org/10.1016/j.soard.2022.05.023.

    Article  PubMed  Google Scholar 

  27. Kassir R, Rebibo L, Genser L, et al. SOFFCO-MM guidelines for the resumption of bariatric and metabolic surgery during and after the Covid-19 pandemic. J Visc Surg. 2020;157:317–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service de Chirurgie Digestive, Oesogastrique Et Bariatrique, Hôpital Bichat Claude Bernard, APHP, 75018, Paris, France

    Evangelia Triantafyllou, Vincent Scholer, Daniela Calabrese, Lara Ribeiro-Parenti & Simon Msika

  2. Service de Chirurgie, GHI Le Raincy-Montfermeil, 93370, Montfermeil, France

    Vincent Scholer

  3. Université de Paris, Inserm UMR 1149, 75018, Paris, France

    Daniela Calabrese, Lara Ribeiro-Parenti, Simon Msika & Lionel Rebibo

  4. Service de Chirurgie Digestive Et Oncologique, Hôpital Européen Georges Pompidou, APHP, 75015, Paris, France

    Lionel Rebibo

Authors
  1. Evangelia Triantafyllou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vincent Scholer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniela Calabrese
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lara Ribeiro-Parenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Simon Msika
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lionel Rebibo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lionel Rebibo.

Ethics declarations

Ethical Approval

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.

Informed Consent

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

Conflict of Interest

The authors declare no competing interests.

Additional information

Previous Communication to a Society or Meeting

Original manuscript without communication during congress.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key Points

1. The interest of routine laboratory monitoring after SG seems limited.

2. Routine biological monitoring only does not allow earlier diagnosis of complications.

3. Routine biological monitoring is associated with increased length of hospital stay.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Triantafyllou, E., Scholer, V., Calabrese, D. et al. Is Routine Post-operative Biological Laboratory Assessment Necessary After Sleeve Gastrectomy?. OBES SURG 34, 707–715 (2024). https://doi.org/10.1007/s11695-024-07065-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-024-07065-z

Keywords

Search

Navigation