Early identification of infectious complications in bariatric surgery by the determination of peritoneal and systemic cytokines.
BACKGROUND
Obesity has become a global epidemic and bariatric surgery is one of the therapeutic tools to deal with it. Postoperative complications can occur, such as staple line dehiscence and anastomotic leaks, leading to increased patient mortality. The diagnosis of these complications is frequently difficult. The objective of the present study was to determine whether peritoneal and systemic cytokines could early detect those complications.


METHODS
All patients who underwent open Roux-en-Y gastric bypass from February 2007 to August 2008 were prospectively evaluated. Blood and peritoneal effluent from the drain were collected for the determination of cytokine levels. We also evaluated the clinical signs and the leukograms of the patients.


RESULTS
A total of 107 obese patients were studied. Ninety patients had no complications; 17 had at least one infectious complication which include five cases of staple line dehiscence. Until the third postoperative day, the vital signs and the leukogram did not predict the onset of infectious complications, but the cytokines (interleukin-1beta and interleukin-6) were early markers of these complications.


CONCLUSIONS
Cytokines are good predictors of poor postoperative evolution in bariatric surgery since peritoneal cytokines diagnose better these infectious complications even before changes in blood count and before the occurrence of clinical manifestations.
Department of Surgery and Anatomy, Medical School of Ribeirão Preto of the University of São Paulo, Ribeirão Preto, SP, Brazil. wsalgado@fmrp.usp.br
Wilson
W
Salgado
Fernando
F
de Queiroz Cunha
José Sebastião
JS
dos Santos
Carla
C
Barbosa Nonino-Borges
Ajith
A
Kumar Sankarankutty
Orlando
O
de Castro E Silva
Reginaldo
R
Ceneviva
D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D010538:Peritonitis / Q000276:immunology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000517:prevention & control; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D015415:Biomarkers; D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha