Early Identification of Infectious Complications in Bariatric Surgery by the Determination of Peritoneal and Systemic Cytokines

• Published in: Obesity surgery Vol. 19; no. 7; pp. 867 - 872
• Main Authors: Salgado, Wilson, de Queiroz Cunha, Fernando, dos Santos, José Sebastião, Barbosa Nonino-Borges, Carla, Kumar Sankarankutty, Ajith, de Castro e Silva, Orlando, Ceneviva, Reginaldo
• Format: Journal Article
• Language: English
• Published: New York Springer New York 01.07.2009; Springer Nature B.V
• Subjects: Adult; Bariatric Surgery - adverse effects; Biomarkers - blood; Clinical Research; Cytokines; Female; Gastrointestinal surgery; Humans; Interleukin-1 - blood; Interleukin-6 - blood; Male; Medicine; Medicine & Public Health; Morbidity; Peritonitis - immunology; Postoperative Complications - diagnosis; Postoperative Complications - prevention & control; Surgery; Surgical Wound Dehiscence - etiology; Surgical Wound Infection - diagnosis; Surgical Wound Infection - prevention & control; Time Factors; Treatment Outcome; Tumor Necrosis Factor-alpha - blood; Inflammatory response; Cytokines; Complications; Bariatric surgery; Staple line dehiscence
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-009-9851-5

Background Obesity has become a global epidemic and bariatric surgery is one of the therapeutic tools to deal with it. Postoperative complications can occur, such as staple line dehiscence and anastomotic leaks, leading to increased patient mortality. The diagnosis of these complications is frequently difficult. The objective of the present study was to determine whether peritoneal and systemic cytokines could early detect those complications. Methods All patients who underwent open Roux-en-Y gastric bypass from February 2007 to August 2008 were prospectively evaluated. Blood and peritoneal effluent from the drain were collected for the determination of cytokine levels. We also evaluated the clinical signs and the leukograms of the patients. Results A total of 107 obese patients were studied. Ninety patients had no complications; 17 had at least one infectious complication which include five cases of staple line dehiscence. Until the third postoperative day, the vital signs and the leukogram did not predict the onset of infectious complications, but the cytokines (interleukin-1β and interleukin-6) were early markers of these complications. Conclusion Cytokines are good predictors of poor postoperative evolution in bariatric surgery since peritoneal cytokines diagnose better these infectious complications even before changes in blood count and before the occurrence of clinical manifestations.