Computed tomography scan versus upper gastrointestinal fluoroscopy for diagnosis of staple line leak following bariatric surgery.
BACKGROUND
The best radiographic modality to diagnose staple line leaks following bariatric surgery remains controversial. Two common studies used are upper gastrointestinal (UGI) fluoroscopy and computed tomography (CT). This study sought to determine the better modality in detecting clinically significant postoperative leaks.


METHODS
This retrospective review was performed of patients undergoing imaging for suspected staple line leaks following bariatric surgery. These studies were reinterpreted by 2 radiologists who were blinded to the original findings.


RESULTS
Six hundred nineteen radiographic "leak tests" were selectively performed following bariatric procedures at our institution between January 2005 and December 2011. CT was found to have a sensitivity of 95% (95% confidence interval [CI] 81.8 to 99.1) and a specificity of 100% (95% CI 93.1 to 100) in diagnosing postoperative leaks, while UGI demonstrated a sensitivity of 79.4% (95% CI 61.6 to 90.0) and a specificity of 95% (95% CI 85.2 to 98.7).


CONCLUSIONS
CT is a superior modality compared with UGI for detecting staple line leaks following bariatric surgery.
Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA. Electronic address: jason.r.bingham4.mil@mail.mil.
Jason
J
Bingham
Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA.
Robert
R
Shawhan
Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA.
Ross
R
Parker
Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA.
Jay
J
Wigboldy
Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA.
Vance
V
Sohn
D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000000981:diagnostic imaging* / Q000209:etiology; D050110:Bariatric Surgery / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D011860:Radiography, Abdominal / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013537:Sutures / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed / Q000379:methods*
Anastomotic leak; Bariatric surgery; Computed tomography; Upper GI fluoroscopy