Original articleDiagnostic value of computed tomography for detecting anastomotic or staple line leakage after bariatric surgery
Section snippets
Study design and study population
All consecutive patients who underwent a bariatric procedure containing an anastomosis or staple line in the period November 2007 until August 2016 were retrospectively reviewed. All patients were operated according to the International Federation for the Surgery of Obesity and Metabolic Disorders criteria for bariatric surgery [9]. The following surgical and revisional procedures were performed by experienced bariatric surgeons or by a resident under their direct supervision: laparoscopic
Patient characteristics
In our study population, 2410 patients underwent a bariatric procedure concerning an anastomosis or staple line (Fig. 1, Table 1). Of the 2410, 121 patients had a clinical suspicion of ASLL. Leakage was diagnosed in 28 (1.2%) patients at a median of 3 (interquartile range, 2–8) days after surgery. Three patients died due to multiorgan failure after ASLL, resulting in a leak-associated mortality of 10.7%.
After laparoscopic Roux-en-Y gastric bypass, ASLL was located at the gastrojejunostomy in 15
Discussion
In the total population, we found a sensitivity of abdominal CT ranging from 77% to 85%, a specificity of 65% to 75%, a PPV of 35% to 45%, and a NPV of 92% to 95%, increasing to 85% to 92%, 66% to 75%, 41% to 45%, and 95% to 97%, respectively, after radiologists received clinical information in the second phase of reevaluation. This increase underlines the importance of providing accurate clinical information to the involved radiologist.
Using original CT reports as the sole reference, Bingham
Conclusion
With an overall sensitivity of 85% to 92% and NPV of 92% to 95%, a negative CT scan can be trusted; it gives high confidence that its negative result is true, especially in patients without the co-existence of tachycardia and tachypnea (sensitivity 89%–100% and NPV of 97%–100%), where a negative CT scan can rule out ASLL. Therefore, CT should be used as a diagnostic modality to triage patients suspected of ASLL and it can subsequently prevent unnecessary performed diagnostic laparoscopy.
Disclosures
The authors have no commercial associations that might be a conflict of interest in relation to this article.
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