Routine intraoperative leak testing for sleeve gastrectomy: is the leak test full of hot air?
| Autor: | Morgan R. Barron, Kelly Blair, Jason Bingham, Matthew J. Martin, John Kuckelman, Preston L. Carter, Michael S. Lallemand |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Sleeve gastrectomy Leak Adolescent medicine.medical_treatment Anastomotic Leak Risk Assessment Sensitivity and Specificity Leak testing Body Mass Index Cohort Studies Young Adult 03 medical and health sciences Postoperative Complications 0302 clinical medicine Gastrectomy Predictive Value of Tests Surgical Stapling medicine Humans Retrospective Studies Intraoperative Care business.industry Retrospective cohort study General Medicine Middle Aged Obesity Morbid Surgery Treatment Outcome 030220 oncology & carcinogenesis Predictive value of tests Staple line Female 030211 gastroenterology & hepatology Complication business Follow-Up Studies |
| Zdroj: | The American Journal of Surgery. 211:943-947 |
| ISSN: | 0002-9610 |
| DOI: | 10.1016/j.amjsurg.2016.02.002 |
| Popis: | Background Staple line leak after sleeve gastrectomy (SG) is a rare but dreaded complication with a reported incidence of 0% to 8%. Many surgeons routinely test the staple line with an intraoperative leak test (IOLT), but there is little evidence to validate this practice. In fact, there is a theoretical concern that the leak test may weaken the staple line and increase the risk of a postop leak. Methods Retrospective review of all SGs performed over a 7-year period was conducted. Cases were grouped by whether an IOLT was performed, and compared for the incidence of postop staple line leaks. The ability of the IOLT for identifying a staple line defect and for predicting a postoperative leak was analyzed. Results Five hundred forty-two SGs were performed between 2007 and 2014. Thirteen patients (2.4%) developed a postop staple line leak. The majority of patients (n = 494, 91%) received an IOLT, including all 13 patients (100%) who developed a subsequent clinical leak. There were no (0%) positive IOLTs and no additional interventions were performed based on the IOLT. The IOLT sensitivity and positive predictive value were both 0%. There was a trend, although not significant, to increase leak rates when a routine IOLT was performed vs no routine IOLT (2.6% vs 0%, P = .6). Conclusions The performance of routine IOLT after SG provided no actionable information, and was negative in all patients who developed a postoperative leak. The routine use of an IOLT did not reduce the incidence of postop leak, and in fact was associated with a higher leak rate after SG. |
| Databáze: | OpenAIRE |
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