Laparoscopic sleeve gastrectomy: A role of inflammatory markers in the early detection of gastric leak

Abstract

Setting: Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as a bariatric option. Gastric leak (GL) is the most dreaded septic complication of LSG. Early detection and treatment of this complication may improve outcomes.

Objectives: This study investigates biomarkers that might be useful to predict GL before its clinical presentation in patients who underwent LSG.

Patients and methods: This study, prospective observational, was carried out in 151 patients, who underwent LSG for morbid obesity between February 2014 and October 2019. Blood samples were collected before the operation and on post-operative days one, three and five to dose serum C-reactive protein (CRP), pro-calcitonin (PCT), fibrinogen, white blood cells (WBCs) count and neutrophil-to-lymphocyte ratio (NLR).

Results: GL occurred in 6 patients (3.97%). According to the receiver operating characteristics curve, NLR detected leak with remarkably higher sensitivity (100%) and specificity (100%) than CRP, fibrinogen, WBC on all the days and higher than PCT in post-operative days 3 and 5. Moreover, the area under the curve (AUC) of NLR (AUC = 1) was higher than the AUC of CRP, fibrinogen, WBC on all the days and higher than PCT in post-operative days 3 and 5, suggesting important statistical significance.

Conclusions: Because NLR and PCT detected GL with remarkably higher sensitivity and specificity than CRP, fibrinogen and WBC, these two markers seem to be more accurate for the early detection of this complication.

Keywords: C-reactive protein; gastric leak; laparoscopic sleeve gastrectomy; neutrophil-to-lymphocyte ratio; procalcitonin.

Figure 1

ROC curve on POD 1 (a), 3 (b) and 5 (c). ROC: Receiver operative carachteristics. PCT: Procalcitonin. CRP: C reactive protein. WBC: White blood cells. NLR: Neuthrophil-to-lymphocyte ratio. POD: Post-operative day