Details

Autor(en) / Beteiligte

• Bingham, Jason, MD
• Lallemand, Michael, MD
• Barron, Morgan, MD
• Kuckelman, John, DO
• Carter, Preston, MD
• Blair, Kelly, MD
• Martin, Matthew, MD

Titel

Routine Intraoperative Leak Testing for Sleeve Gastrectomy: Is the Leak Test Full of Hot Air?

Ist Teil von

• The American journal of surgery, 2016-05, Vol.211 (5), p.943-947

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2016

Quelle

Elsevier ScienceDirect Journals

Beschreibungen/Notizen

• Abstract Introduction Staple line leak after sleeve gastrectomy (SG) is a rare but dreaded complication with a reported incidence of 0-8%. Many surgeons routinely test the staple line with an intraoperative leak test, but there is little evidence to validate this practice. In fact, there is a theoretical concern that the leak test may weaken the staple line and increase the risk of a postop leak. Methods Retrospective review of all SG performed over a 7-year period. Cases were grouped by whether an intraoperative leak test (IOLT) was performed, and compared for the incidence of postop staple line leaks. The ability of the IOLT for identifying a staple line defect and for predicting a postoperative leak was analyzed. Results 542 SG were performed between 2007-2014. 13 patients (2.4%) developed a postop staple line leak. The majority of patients (N=494, 91%) received an IOLT, including all 13 patients (100%) who developed a subsequent clinical leak. There were no (0%) positive IOLTs and no additional interventions were performed based on the IOLT. The IOLT sensitivity and positive predictive value were both 0%. There was a trend, although not significant, to increased leak rates when a routine IOLT was performed versus no routine IOLT (2.6% vs. 0%, p=0.6). Conclusions The performance of routine IOLT after sleeve gastrectomy provided no actionable information, and was negative in all patients who developed a postoperative leak. The routine use of an IOLT did not reduce the incidence of postop leak, and in fact was associated with a higher leak rate after SG.