Challenges in the Diagnosis of Leak After Sleeve Gastrectomy: Clinical Presentation, Laboratory, and Radiological Findin
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ORIGINAL CONTRIBUTIONS
Challenges in the Diagnosis of Leak After Sleeve Gastrectomy: Clinical Presentation, Laboratory, and Radiological Findings Mohammad Al Zoubi 1
&
Nesreen Khidir 2 & Moataz Bashah 2,3
Received: 28 May 2020 / Revised: 18 September 2020 / Accepted: 23 September 2020 # The Author(s) 2020
Abstract 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/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. 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. Keywords Diagnosis of leak post sleeve gastrectomy . Post LSG leak . Misdiagnosis of leak post LSG . Post LSG complications
Introduction Despite the decreasing worldwide incidence over time, gastrointestinal leak remains a significant cause of morbidity and mortality after bariatric surgeries [1]. Leakage rates after laparoscopic sleeve gastrectomy (LSG) were reported ranging from 0.4 to 2.7% in primary procedures and 10% in revisional procedures [2–4].
Post LSG leaks can be misdiagnosed, resulting in delayed management and catastrophic consequences [5]. The clinical presentation, signs, and symptoms are highly variable, ranging from asymptomatic to septic shock [6]. Debate exists on what is the best diagnostic modality in diagnosing LSG leak. 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]. This study shares our experience in treating a large number of LSG leaks at a single center, detailing the clinical pres
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