A multicenter study of routine versus selective intraoperative leak testing for sleeve gastrectomy

作者：Bingham Jason^*; Kaufman Jedediah; Hata Kai; Dickerson James; Beekley Alec; Wi**ach Gordon; Swann Jacob; Ahnfeldt Eric; Hawkins Devon; Choi Yong; Lim Robert; Martin Matthew

来源：Surgery for Obesity and Related Diseases, 2017, 13(9): 1469-1475.

DOI：10.1016/j.soard.2017.05.022

• Bariatric surgery
• Sleeve gastrectomy
• Staple line leak
• Intraoperative leak test

Background: Staple line leaks after sleeve gastrectomy are dreaded complications. Many surgeons routinely perform an intraoperative leak test (IOLT) despite little evidence to validate the reliability, clinical benefit, and safety of this procedure.
Objectives: To determine the efficacy of IOLT and if routine use has any benefit over selective use.
Setting: Eight teaching hospitals, including private, university, and military facilities.
Methods: A multicenter, retrospective analysis over a 5-year period. The efficacy of the IOLT for identifying unsuspected staple line defects and for predicting postoperative leaks was evaluated. An anonymous survey was also collected reflecting surgeons' practices and beliefs regarding IOLT.
Results: From January 2010 through December 2014, 4284 patients underwent sleeve gastrectomy. Of these, 37 patients (.9%) developed a postoperative leak, and 2376 patients (55%) received an IOLT. Only 2 patients (0.08%) had a positive finding. Subsequently, 21 patients with a negative IOLT developed a leak. IOLT demonstrated a sensitivity of only 8.7%. There was a nonsignificant trend toward increased leak rates when an IOLT was performed versus when IOLT was not performed. Leak rates were not statistically different between centers that routinely perform IOLT versus those that selectively perform IOLT.
Conclusions: Routine IOLT had very poor sensitivity and was negative in 91% of patients who later developed postoperative leaks. The use of IOLT was not associated with a decrease in the incidence of postoperative leaks, and routine IOLT had no benefit over selective leak testing. IOLT should not be used as a quality indicator or "best practice" for bariatric surgery. Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery.

• 出版日期2017-9