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

• Published in: Obesity surgery Vol. 31; no. 2; pp. 612 - 616
• Main Authors: Al Zoubi, Mohammad, Khidir, Nesreen, Bashah, Moataz
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2021; Springer Nature B.V
• Subjects: Abdomen; Adult; Anastomotic Leak - diagnostic imaging; Anastomotic Leak - etiology; Cardiac arrhythmia; Gastrectomy - adverse effects; Humans; Laboratories; Laparoscopy; Medicine; Medicine & Public Health; Middle Aged; Obesity, Morbid - surgery; Original Contributions; Retrospective Studies; Surgery; Treatment Outcome; Misdiagnosis of leak post LSG; Post LSG complications; Post LSG leak; Diagnosis of leak post sleeve gastrectomy
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-020-05008-y

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/mm 3 ), 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.