The usefulness and costs of routine contrast studies after laparoscopic sleeve gastrectomy for detecting staple line leaks

Although laparoscopic sleeve gastrectomy (LSG) has been shown to be a safe and effective treatment for severe obesity (body mass index ≥ 35), staple line leaks remain a major complication and account for a substantial portion of the procedure's morbidity and mortality. Many centres performing L...

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Bibliographic Details
Published in:	Canadian Journal of Surgery Vol. 60; no. 5; pp. 335 - 341
Main Authors:	Terterov, Dimitry, Leung, Philemon Ho-Yan, Twells, Laurie K, Gregory, Deborah M, Smith, Chris, Boone, Darrell, Pace, David
Format:	Journal Article
Language:	English
Published:	Canada Joule Inc 01-10-2017 CMA Impact, Inc
Subjects:	Adult Body mass index Contrast Media Costs Diatrizoate Meglumine Endoscopy, Gastrointestinal Female Fluoroscopy - economics Fluoroscopy - methods Fluoroscopy - standards Gastrectomy - methods Gastrointestinal surgery Health aspects Humans Laparoscopy Male Medical imaging Medical procedures Middle Aged Mortality Obesity Obesity, Morbid - surgery Patients Postoperative Complications - diagnostic imaging Retrospective Studies Sensitivity and Specificity Statistical analysis Studies Surgery Surgical Stapling - adverse effects Time Factors Weight control Canada
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Summary:	Although laparoscopic sleeve gastrectomy (LSG) has been shown to be a safe and effective treatment for severe obesity (body mass index ≥ 35), staple line leaks remain a major complication and account for a substantial portion of the procedure's morbidity and mortality. Many centres performing LSG routinely obtain contrast studies on postoperative day 1 for early detection of staple line leaks. We examined the usefulness of Gastrografin swallow as an early detection test for staple line leaks on postoperative day 1 after LSG as well as the associated costs. We conducted a retrospective review of a prospectively collected database that included 200 patients who underwent LSG for severe obesity between 2011 and 2014. Primary outcome measures were the incidence of staple line leaks and the results of Gastrografin swallow tests. We obtained imaging costs from appropriate hospital departments. Gastrografin swallow was obtained on postoperative day 1 for all 200 patients who underwent LSG. Three patients (1.5%) were found to have staple line leaks. Gastrograffin swallows yielded 1 true positive result and 2 false negatives. The false negatives were subsequently diagnosed on computed tomography (CT) scan. The sensitivity of Gastrografin swallow in this study was 33%. For 200 patients, the total direct cost of the Gastrografin swallows was $35 000. The use of routine upper gastrointestinal contrast studies for early detection of staple line leaks has low sensitivity and is costly. We recommend selective use of CT instead.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0008-428X 1488-2310
DOI:	10.1503/cjs.015216