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Leakage Risk Stratification After Laparoscopic Sleeve Gastrectomy (LSG): Is There a Role for Routine Postoperative CT Scan?

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Abstract

Purpose

Leakage of the gastric remnant after laparoscopic sleeve gastrectomy (LSG) represents an unpredictable, dreadful occurrence. Our aim was to assess whether routine postoperative CT scan is an effective tool for early prediction of leakage after LSG.

Materials and Methods

From a prospectively acquired database, all consecutive patients who underwent LSG between January 2015 and December 2018 were identified; within this database, all patients who were evaluated with at least one contrast-enhanced CT scan within 48 h from surgery were enrolled in this retrospective study. The selected CT findings included twisting of the gastric remnant, perigastric air bubbles, and hematoma; the antral segment proximal from the pylorus to the first staple firing was also analyzed in terms of distance (StP, stapler to pylorus distance) and linearity (LI, linearity index).

Results

After exclusions, 250 patients were included; 10 patients suffered from gastric leakage. Patients with perigastric hematoma and/or twisting of the distal part of the gastric remnant on routine postoperative CT scan were found to be more likely to develop leakage after LSG (p = 0.005 and p < 0.001, respectively). The mean StP was 45 ± 19.1 mm; the mean LI was 1.54 ± 0.4. Patients with subsequent development of leakage had significantly lower StP (26.7 ± 12.5 mm vs. 45.9 ± 18.9 mm; p = 0.001) and LI values (1.16 ± 0.11 vs. 1.55 ± 0.39; p = 0.002).

Conclusion

Routine postoperative CT scan after LSG permits early stratification of leakage risk, thus providing an actual aid for patients’ management.

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Authors and Affiliations

  1. Radiology Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy

    Diego Palumbo, Carlo Martinenghi, Giorgia Guazzarotti, Riccardo Leone, Roberto Nicoletti & Francesco De Cobelli

  2. San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy

    Diego Palumbo, Riccardo Rosati & Francesco De Cobelli

  3. Metabolic, Bariatric and Transplant Surgery Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy

    Carlo Socci

  4. GastroIntestinal Surgery Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy

    Riccardo Rosati

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  1. Diego Palumbo
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  2. Carlo Socci
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  3. Carlo Martinenghi
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  4. Giorgia Guazzarotti
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Correspondence to Diego Palumbo.

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The authors declare that they have no conflict of interest.

Ethical Approval Statement

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.

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Informed consent was obtained from all individual participants included in the study, according to Ethics Committee requirements.

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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 30, 3370–3377 (2020). https://doi.org/10.1007/s11695-020-04586-1

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