Mohammad Al Zoubi1, Nesreen Khidir2, Moataz Bashah2,3. 1. General Surgery Department, Hamad Medical Corporation, Hamad General Hospital, P.O. Box: 3050, Doha, Qatar. m_zoubi@hotmail.com. 2. Bariatric and Metabolic Surgery Department, Hamad Medical Corporation, Doha, Qatar. 3. Weil Cornel Medical College, Doha, Qatar.
Abstract
BACKGROUND: The presentation of leak after laparoscopic sleeve gastrectomy (LSG) is variable. A missed or delayed diagnosis can lead to severe consequences. This study presents our experience: the clinical presentations, laboratory, and radiological findings in patients with leak after LSG. METHODS: A retrospective review of patients who were diagnosed and treated as leak after LSG at our center (January 2012-November 2019). RESULTS: Eighty patients developed leak: 68 (85%) after primary LSG, 6 (7.5%) after Re-LSG and 6 (7.5%) after band removal to revisional LSG. Mean age 35.9 ± 10 years. The diagnosis was within 18 ± 14 days after surgery. Five (6.3%) patients were diagnosed during the same admission. Only 29.3% of patients were diagnosed correctly from the first visit to the ER. Most were misdiagnosed as gastritis (49%) and pneumonia (22.6%). Thirty-four patients (45.3%) were diagnosed correctly at the third visit. The most common presenting symptoms were abdominal pain (90%), tachycardia (71.3%), and fever (61.3%). The mean white blood cells (WBCs) count was 14700 ± 5900 (cells/mm3), c-reactive protein (CRP) 270 ± 133 mg/L, lactic acid 1.6 ± 0.85 mmol/L, and albumin 30.3 ± 6.6 g/L. The abdominal CT scans revealed intraabdominal collection in 93.7% of patients, extravasation of contrast in 75%, and pleural effusion in 52.5%. Upper gastrointestinal contrast study (UGIC) showed extravasation of contrast in 77.5% of patients. CONCLUSION: Abdominal pain, tachycardia, or fever after LSG should raise the suspicion of a leak. CT scan of the abdomen and UGIC study detected leaks in 75% and 77.5% consecutively. Only 29.3% of patients were diagnosed correctly as a leak from the first visit to the ER.
BACKGROUND: The presentation of leak after laparoscopic sleeve gastrectomy (LSG) is variable. A missed or delayed diagnosis can lead to severe consequences. This study presents our experience: the clinical presentations, laboratory, and radiological findings in patients with leak after LSG. METHODS: A retrospective review of patients who were diagnosed and treated as leak after LSG at our center (January 2012-November 2019). RESULTS: Eighty patients developed leak: 68 (85%) after primary LSG, 6 (7.5%) after Re-LSG and 6 (7.5%) after band removal to revisional LSG. Mean age 35.9 ± 10 years. The diagnosis was within 18 ± 14 days after surgery. Five (6.3%) patients were diagnosed during the same admission. Only 29.3% of patients were diagnosed correctly from the first visit to the ER. Most were misdiagnosed as gastritis (49%) and pneumonia (22.6%). Thirty-four patients (45.3%) were diagnosed correctly at the third visit. The most common presenting symptoms were abdominal pain (90%), tachycardia (71.3%), and fever (61.3%). The mean white blood cells (WBCs) count was 14700 ± 5900 (cells/mm3), c-reactive protein (CRP) 270 ± 133 mg/L, lactic acid 1.6 ± 0.85 mmol/L, and albumin 30.3 ± 6.6 g/L. The abdominal CT scans revealed intraabdominal collection in 93.7% of patients, extravasation of contrast in 75%, and pleural effusion in 52.5%. Upper gastrointestinal contrast study (UGIC) showed extravasation of contrast in 77.5% of patients. CONCLUSION:Abdominal pain, tachycardia, or fever after LSG should raise the suspicion of a leak. CT scan of the abdomen and UGIC study detected leaks in 75% and 77.5% consecutively. Only 29.3% of patients were diagnosed correctly as a leak from the first visit to the ER.
Entities:
Keywords:
Diagnosis of leak post sleeve gastrectomy; Misdiagnosis of leak post LSG; Post LSG complications; Post LSG leak
Authors: G Casella; E Soricelli; M Rizzello; P Trentino; F Fiocca; A Fantini; F M Salvatori; N Basso Journal: Obes Surg Date: 2009-04-21 Impact factor: 4.129
Authors: William Bertucci; Stephen White; John Yadegar; Kaushal Patel; Soo Hwa Han; Oliver Blocker; Deborah Frickel; Barbara Kadell; Amir Mehran; Carlos Gracia; Erik Dutson Journal: Am Surg Date: 2006-10 Impact factor: 0.688
Authors: Melissa Nespeca Mendes; Rosana de Souza Monteiro; Fernando Antonio Nogueira da Cruz Martins Journal: Rev Bras Anestesiol Date: 2009 Sep-Oct Impact factor: 0.964
Authors: Ana Maria Burgos; Italo Braghetto; Attila Csendes; Fernando Maluenda; Owen Korn; Julio Yarmuch; Luis Gutierrez Journal: Obes Surg Date: 2009-12 Impact factor: 4.129
Authors: Lucia Romano; Antonio Giuliani; Marino Di Furia; Danilo Meloni; Giovanni Cianca; Antonella Mattei; Fabiana Fiasca; Emilio Tonelli; Francesco Carlei; Mario Schietroma Journal: Med Princ Pract Date: 2021-06-22 Impact factor: 1.927
Authors: Gennaro Martines; Giovanni Tomasicchio; Arcangelo Picciariello; Rigers Dibra; Giuseppe Trigiante; Giuliano Lantone; Donato Francesco Altomare Journal: Open Med (Wars) Date: 2022-01-19