title: Prospective evaluation of routine early computed tomography scanner in laparoscopic sleeve gastrectomy.
abstract: BACKGROUND
  Prompt management of laparoscopic sleeve gastrectomy (LSG) complications is essential in avoiding prolonged hospital stay and associated mortality. The value of routine computed tomography (CT) scan examination in early diagnosis of postoperative complications after LSG has not been studied.
  
  
  OBJECTIVE
  To prospectively assess the impact of postoperative day (POD) 2 CT scan after LSG.
  
  
  METHODS
  Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, Paris-Saclay University, France.
  
  
  METHODS
  Data were prospectively gathered for 1000 patients undergoing single-incision LSG and POD 2 CT scan. Complications were identified and treatment modalities decided according to the severity of complications. Sensitivity, specificity, and positive and negative predictive values were calculated for the diagnosis of surgical complications on POD 2 CT scan.
  
  
  RESULTS
  Mean age was 40.1 years and median BMI 42.6 kg/m². Early postoperative surgical complications occurred in 66 patients (6.6%). Intraabdominal bleeding/hematoma occurred in 38 patients, with 3 requiring emergent reoperation on POD 1. POD 2 CT scan detected this complication in 32 patients (sensitivity: 91.4%). Twenty-four (63.1%) patients were treated with relaparoscopy and drainage while 14 (36.9%) received conservative management. Postoperative transfusion was required in 7 patients. Twenty-eight patients suffered a gastric staple line leak, 13 (sensitivity: 46.4%) detected on POD 2 CT scan. Three patients (10.7%) received pure surgical treatment, 16 (57.1%) combined relaparoscopy and endoscopic treatment, and 9 (32.2%) had pure endoscopic treatment.
  
  
  CONCLUSIONS
  POD 2 abdominal CT scan is an efficient diagnostic tool for detecting active bleeding/hematoma, but shows less impressive results with gastric staple line leak detection. A combination of clinical surveillance and early imaging allowed prompt management of complicated cases, avoiding further morbidity.
authors.affiliation: Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, Clamart, France; Paris-Saclay University, Orsay, France.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Lainas
authors.affiliation: Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, Clamart, France; Paris-Saclay University, Orsay, France.
authors.forename: Hadrien
authors.initials: H
authors.lastname: Tranchart
authors.affiliation: Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, Clamart, France; Paris-Saclay University, Orsay, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Gaillard
authors.affiliation: Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, Clamart, France.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferretti
authors.affiliation: Department of Interventional Endoscopy, Peupliers Private Hospital, Paris, France.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Donatelli
authors.affiliation: Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, Clamart, France; Paris-Saclay University, Orsay, France. Electronic address: ibrahim.dagher@abc.aphp.fr.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Dagher
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000000981:diagnostic imaging / Q000209:etiology; D050110:Bariatric Surgery / Q000009:adverse effects / Q000295:instrumentation*; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000295:instrumentation*; D005747:Gastric Fistula / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery; D061646:Operative Time; D011182:Postoperative Care / Q000295:instrumentation; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011446:Prospective Studies; D015898:Tomography Scanners, X-Ray Computed; D014057:Tomography, X-Ray Computed
keywords: Bariatric surgery; CT scan; Fistula; Hematoma; Obesity; Sleeve gastrectomy; Staple line leak; single-incision