Challenges in the Diagnosis of Leak After Sleeve Gastrectomy: Clinical Presentation, Laboratory, and Radiological Findings

Mohammad Al Zoubi,Nesreen Khidir,Moataz Bashah

doi:10.1007/s11695-020-05008-y

Abstract

BackgroundThe 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.MethodsA retrospective review of patients who were diagnosed and treated as leak after LSG at our center (January 2012–November 2019).ResultsEighty 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.ConclusionAbdominal 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.

Highlights

Despite the decreasing worldwide incidence over time, gastrointestinal leak remains a significant cause of morbidity and mortality after bariatric surgeries [1]
Though all agreed that early detection is associated with a better outcome, and a high index of suspicion is the cornerstone in the diagnosis [5, 7, 8]
Out of the eighty patients, only twenty patients (25%) had laparoscopic sleeve gastrectomy (LSG) done at our center

Summary

Introduction

Despite the decreasing worldwide incidence over time, gastrointestinal leak remains a significant cause of morbidity and mortality after bariatric surgeries [1]. Post LSG leaks can be misdiagnosed, resulting in delayed management and catastrophic consequences [5]. This study shares our experience in treating a large number of LSG leaks at a single center, detailing the clinical presentations, laboratory, and radiological findings. The presentation of leak after laparoscopic sleeve gastrectomy (LSG) is variable. This study presents our experience: the clinical presentations, laboratory, and radiological findings in patients with leak after LSG. 29.3% of patients were diagnosed correctly from the first visit to the ER. Thirty-four patients (45.3%) were diagnosed correctly at the third visit. Conclusion Abdominal pain, tachycardia, or fever after LSG should raise the suspicion of a leak. 29.3% of patients were diagnosed correctly as a leak from the first visit to the ER

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