[The role of early predictors in diagnosis of stapler suture and anastomotic failure in bariatric patients].

Abstract

Objective: To study the role of early predictors in diagnosis of stapler suture and anastomotic failure in bariatric patients and to determine the indications for redo laparoscopy.

Material and methods: A single-center retrospective study enrolled 2011 patients who underwent surgery. All patients were categorized into two groups: group 1 (1983 patients) - standard postoperative period; group 2 (28 patients) - major inflammatory complications with redo laparoscopy.

Results: We found no significant differences in BMI, weight and age between patients with and without complications. Conversely, high serum glucose, duration of type 2 DM over 5 years, tachycardia > 100 bpm and high VAS score of abdominal pain significantly increased the risk of complications. Contrast-enhanced CT of the abdomen has the greatest informative value. To ascertain critical value of each factor for between-group differentiation, we performed ROC analysis and demonstrated specificity of these indicators.

Conclusion: The challenge of early diagnosis of intra-abdominal inflammatory complications in bariatric patients is compounded by no typical symptoms and small informative value of laboratory and instrumental diagnostic methods. According to ROC analysis, combination of fever, hypotension, tachycardia and tachypnoea resulted AUC 0.80. Sensitivity 65% and specificity 82% indicated the need for immediate repeated surgery. However, availability of standardized surgical technique and clear algorithms for the entire team are essential for timely diagnosis and management of all potential complications in patients with serious postoperative bariatric complications.