Laparoscopic sleeve gastrectomy

Abstract

Setting: Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as a bariatric option. Gastric leak (GL) is the most dreaded septic complication of LSG. Early detection and treatment of this complication may improve outcomes. Objectives: This study investigates biomarkers that might be useful to predict GL before its clinical presentation in patients who underwent LSG. Patients and Methods: This study, prospective observational, was carried out in 151 patients, who underwent LSG for morbid obesity between February 2014 and October 2019. Blood samples were collected before the operation and on post-operative days one, three and five to dose serum C-reactive protein (CRP), pro-calcitonin (PCT), fibrinogen, white blood cells (WBCs) count and neutrophil-to-lymphocyte ratio (NLR). Results: GL occurred in 6 patients (3.97%). According to the receiver operating characteristics curve, NLR detected leak with remarkably higher sensitivity (100%) and specificity (100%) than CRP, fibrinogen, WBC on all the days and higher than PCT in post-operative days 3 and 5. Moreover, the area under the curve (AUC) of NLR (AUC = 1) was higher than the AUC of CRP, fibrinogen, WBC on all the days and higher than PCT in post-operative days 3 and 5, suggesting important statistical significance. Conclusions: Because NLR and PCT detected GL with remarkably higher sensitivity and specificity than CRP, fibrinogen and WBC, these two markers seem to be more accurate for the early detection of this complication.

Machine Learning-based Correlation Study between Perioperative Immunonutritional Index and Postoperative Anastomotic Leakage in Patients with Gastric Cancer

“…From the univariant analysis in this study, we found that CRP on POD 4 achieved optimal AUROC of 0.857 with a cutoff value of 159.5 (Figure 2). This result echoed afar with numerous researches recently [27][28][29][30][31] , suggesting that CRP was one of the most commonly used and widely verified clinical predictors for postoperative AL and other postoperative infections. Other variables presenting great potential include NLR on POD 4 (AUROC=0.802, cutoff value=10.55), minimum serum albumin during hospitalization (AUROC=0.7475, cutoff value=32.25) (Figure 2), which also indicated that poor overall immunonutritional internal environment may increase risk of postoperative AL.…”

Drain Amylase Levels in the Early Diagnosis of Gastric Leak after Laparoscopic Sleeve Gastrectomy

“…Many studies have shown that inflammatory scores can improve the accuracy of complication prediction after bariatric surgery [21][22][23][24]. The determination of amylase in the drain liquid apparently may be an inexpensive and easily available tool (in the same way as inflammatory markers) to help in this regard.…”

Endoscopic Double-Pigtail Catheter (EDPC) Internal Drainage as First-Line Treatment of Gastric Leak: A Case Series during Laparoscopic Sleeve Gastrectomy Learning Curve for Morbid Obesity

“…This endoscopic approach has several potential advantages [ 22 ], including its minimally invasive nature, lack of influence of BMI, and the minimal inflammation produced by the procedure, which does not interfere with the healing process [ 23 ].…”