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

• DOI: 10.1007/s11695-020-05008-y
• Publication Date: 2020-10-06T23:07:10Z
• Authors: Mohammad Al Zoubi; Nesreen Khidir; Moataz Bashah
• Keywords: Sleeve gastrectomy; Extravasation

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 LSG. Methods retrospective review who were diagnosed treated as LSG at center (January 2012–November 2019). Results Eighty developed leak: 68 (85%) primary LSG, 6 (7.5%) Re-LSG band removal revisional Mean age 35.9 ± 10 years. was within 18 14 days surgery. Five (6.3%) during same admission. Only 29.3% correctly from first visit ER. Most misdiagnosed gastritis (49%) pneumonia (22.6%). Thirty-four (45.3%) third visit. most common presenting symptoms abdominal pain (90%), tachycardia (71.3%), fever (61.3%). mean white blood cells (WBCs) count 14700 5900 (cells/mm 3 ), c-reactive protein (CRP) 270 133 mg/L, lactic acid 1.6 0.85 mmol/L, albumin 30.3 6.6 g/L. CT scans revealed intraabdominal collection 93.7% patients, extravasation contrast 75%, pleural effusion 52.5%. Upper gastrointestinal (UGIC) showed 77.5% patients. Conclusion Abdominal pain, tachycardia, should raise suspicion a leak. scan abdomen UGIC detected leaks 75% consecutively.