title: Usefulness of Clinical Signs and Diagnostic Tests for Suspected Leaks in Bariatric Surgery.
abstract: BACKGROUND
  The early diagnosis of leakage poses a challenge to bariatric surgeons, who need to suspect and treat it promptly. The aim of this study is to determine the value of clinical signs and complementary tests in its detection.
  
  
  METHODS
  Between January 2007 and 2012, 200 patients underwent surgery for pathological obesity. Perioperative variables were collected prospectively, and univariate and multivariate analyses were conducted to study the factors related to leak occurrence and the predictive value of the tests performed.
  
  
  RESULTS
  The study includes 172 proximal gastric bypasses and 28 sleeve gastrectomies. Nine patients (4.5 %) had leaks in the immediate postoperative period. Multivariate analyses found that age over 48 years and preoperative BMI > 48 kg/m(2) were the patient-related variables associated with a higher risk of leakage. The clinical variables significantly related to postoperative leaks were heart rate over 100 bpm, leukocytes over 15,000/mm(3) and systolic arterial pressure below 100 mmHg. In patients with a clinical suspicion of leakage (n = 19), 7.7 % of abdominal CT scans returned false negatives, versus 28.6 % for oral methylene blue and 22.2 % for upper gastrointestinal (UGI) Gastrografin swallow [Corrected].
  
  
  CONCLUSIONS
  Bariatric surgery proved to be a safe technique at our medical centre. Patient-related variables associated with a higher risk of leakage were age and BMI. Early clinical signs of leakage were tachycardia, leukocytosis and hypotension. The most reliable diagnostic test was the abdominal CT scan.
authors: Department of Surgery, University Hospital of Canaries (HUC), Santa Cruz de Tenerife, Spain, ivanhuc@hispavista.com.
authors: I
authors: I
authors: Arteaga-González
authors: A
authors: A
authors: Martín-Malagón
authors: J
authors: J
authors: Martín-Pérez
authors: A
authors: A
authors: Carrillo-Pallarés
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D050110:Bariatric Surgery / Q000009:adverse effects; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult