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Prospective evaluation of routine early computed tomography scanner in laparoscopic sleeve gastrectomy.
- Source :
-
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery [Surg Obes Relat Dis] 2016 Sep - Oct; Vol. 12 (8), pp. 1483-1490. Date of Electronic Publication: 2016 Mar 31. - Publication Year :
- 2016
-
Abstract
- Background: Prompt management of laparoscopic sleeve gastrectomy (LSG) complications is essential in avoiding prolonged hospital stay and associated mortality. The value of routine computed tomography (CT) scan examination in early diagnosis of postoperative complications after LSG has not been studied.<br />Objectives: To prospectively assess the impact of postoperative day (POD) 2 CT scan after LSG.<br />Setting: Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, Paris-Saclay University, France.<br />Methods: Data were prospectively gathered for 1000 patients undergoing single-incision LSG and POD 2 CT scan. Complications were identified and treatment modalities decided according to the severity of complications. Sensitivity, specificity, and positive and negative predictive values were calculated for the diagnosis of surgical complications on POD 2 CT scan.<br />Results: Mean age was 40.1 years and median BMI 42.6 kg/m². Early postoperative surgical complications occurred in 66 patients (6.6%). Intraabdominal bleeding/hematoma occurred in 38 patients, with 3 requiring emergent reoperation on POD 1. POD 2 CT scan detected this complication in 32 patients (sensitivity: 91.4%). Twenty-four (63.1%) patients were treated with relaparoscopy and drainage while 14 (36.9%) received conservative management. Postoperative transfusion was required in 7 patients. Twenty-eight patients suffered a gastric staple line leak, 13 (sensitivity: 46.4%) detected on POD 2 CT scan. Three patients (10.7%) received pure surgical treatment, 16 (57.1%) combined relaparoscopy and endoscopic treatment, and 9 (32.2%) had pure endoscopic treatment.<br />Conclusion: POD 2 abdominal CT scan is an efficient diagnostic tool for detecting active bleeding/hematoma, but shows less impressive results with gastric staple line leak detection. A combination of clinical surveillance and early imaging allowed prompt management of complicated cases, avoiding further morbidity.<br /> (Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Anastomotic Leak diagnostic imaging
Anastomotic Leak etiology
Bariatric Surgery adverse effects
Body Mass Index
Female
Gastrectomy adverse effects
Gastric Fistula etiology
Humans
Length of Stay
Male
Obesity, Morbid surgery
Operative Time
Postoperative Care instrumentation
Postoperative Complications diagnostic imaging
Prospective Studies
Tomography, X-Ray Computed
Bariatric Surgery instrumentation
Gastrectomy instrumentation
Laparoscopy adverse effects
Tomography Scanners, X-Ray Computed
Subjects
Details
- Language :
- English
- ISSN :
- 1878-7533
- Volume :
- 12
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 27387688
- Full Text :
- https://doi.org/10.1016/j.soard.2016.03.031