Mario Musella1, Valeria Cantoni2, Roberta Green2, Wanda Acampa2, Nunzio Velotti2, Paola Maietta2, Alberto Cuocolo2. 1. Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy. mario.musella@unina.it. 2. Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy.
Abstract
BACKGROUND: To demonstrate the lack of utility and efficacy of routine early postoperative upper gastrointestinal study (UGI) in obese patients undergoing bariatric surgery and to show the higher efficacy of CT scan in cases of clinical suspicion of a leakage, a meta-analysis was performed. MATERIALS AND METHODS: A literature search including articles published in last 18 years was performed. For both UGI and CT scan, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. A first analysis considered overall patients, and a second analysis considered only symptomatic patients. RESULTS: Starting from 1233 eligible citations, 18 articles, including 7516 patients, were left. The pooled sensitivity was 54% for UGI (95% CI 34-74) with a high heterogeneity (I2 = 99.8%, p < .001), whereas CT scan showed a pooled sensitivity of 91% (95% CI 89-93) significantly higher than sensitivity of UGI series (p < 0.01), with a high heterogeneity (I2 = 98.9%, p < .001). In symptomatic patients the pooled sensitivity of UGI series was significantly lower than sensitivity of CT scan [49% (95% CI 31-68) vs 94% (95% CI 92-96), p < 0.01]. PPV showed a significant difference between UGI series and CT scan (54 vs 100%, p < 0.01). Specificity for UGI series was 98.6%, and specificity for CT scan was 99.7% (p = ns); the mean NPV was 96 and 98% for UGI series and CT scan (p = ns). CONCLUSIONS: According to our results, a CT scan triggered by clinical suspicion must be considered the first-line procedure to detect a postoperative leak following primary sleeve gastrectomy or Roux-en-Y gastric bypass.
BACKGROUND: To demonstrate the lack of utility and efficacy of routine early postoperative upper gastrointestinal study (UGI) in obesepatients undergoing bariatric surgery and to show the higher efficacy of CT scan in cases of clinical suspicion of a leakage, a meta-analysis was performed. MATERIALS AND METHODS: A literature search including articles published in last 18 years was performed. For both UGI and CT scan, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. A first analysis considered overall patients, and a second analysis considered only symptomatic patients. RESULTS: Starting from 1233 eligible citations, 18 articles, including 7516 patients, were left. The pooled sensitivity was 54% for UGI (95% CI 34-74) with a high heterogeneity (I2 = 99.8%, p < .001), whereas CT scan showed a pooled sensitivity of 91% (95% CI 89-93) significantly higher than sensitivity of UGI series (p < 0.01), with a high heterogeneity (I2 = 98.9%, p < .001). In symptomatic patients the pooled sensitivity of UGI series was significantly lower than sensitivity of CT scan [49% (95% CI 31-68) vs 94% (95% CI 92-96), p < 0.01]. PPV showed a significant difference between UGI series and CT scan (54 vs 100%, p < 0.01). Specificity for UGI series was 98.6%, and specificity for CT scan was 99.7% (p = ns); the mean NPV was 96 and 98% for UGI series and CT scan (p = ns). CONCLUSIONS: According to our results, a CT scan triggered by clinical suspicion must be considered the first-line procedure to detect a postoperative leak following primary sleeve gastrectomy or Roux-en-Y gastric bypass.
Authors: Marco Milone; Ugo Elmore; Enrico Di Salvo; Paolo Delrio; Luigi Bucci; Giuseppe Paolo Ferulano; Carmine Napolitano; Maria Rachele Angiolini; Umberto Bracale; Marco Clemente; Michele D'ambra; Gaetano Luglio; Mario Musella; Ugo Pace; Riccardo Rosati; Francesco Milone Journal: Surg Endosc Date: 2014-11-21 Impact factor: 4.584
Authors: N Velotti; M Manigrasso; K Di Lauro; A Vitiello; G Berardi; D Manzolillo; P Anoldo; A Bocchetti; F Milone; M Milone; G D De Palma; M Musella Journal: J Obes Date: 2019-01-03
Authors: Belinda De Simone; Elie Chouillard; Almino C Ramos; Gianfranco Donatelli; Tadeja Pintar; Rahul Gupta; Federica Renzi; Kamal Mahawar; Brijesh Madhok; Stefano Maccatrozzo; Fikri M Abu-Zidan; Ernest E Moore; Dieter G Weber; Federico Coccolini; Salomone Di Saverio; Andrew Kirkpatrick; Vishal G Shelat; Francesco Amico; Emmanouil Pikoulis; Marco Ceresoli; Joseph M Galante; Imtiaz Wani; Nicola De' Angelis; Andreas Hecker; Gabriele Sganga; Edward Tan; Zsolt J Balogh; Miklosh Bala; Raul Coimbra; Dimitrios Damaskos; Luca Ansaloni; Massimo Sartelli; Nikolaos Parasas; Yoram Kluger; Elias Chahine; Vanni Agnoletti; Gustavo Fraga; Walter L Biffl; Fausto Catena Journal: World J Emerg Surg Date: 2022-09-27 Impact factor: 8.165