ABSTRACT
Objectives:
Laparoscopic sleeve gastrectomy (LSG) is among the most effective surgical interventions in the long-term prevention of morbid obesity. Stapler line leaks and stapler line bleedings are important complications, which affect morbidity and mortality. The aim of this study is to determine the role of plasma presepsin levels for detection of stapler leaks.
Methods:
Sixty patients with LSG due to morbid obesity and 40 controls were included in this prospective study, which was carried out between April 2016 and July 2016 in our clinic. Patients were evaluated by a multidisciplinary team before surgery in accordance with the protocol of our hospital. Blood samples were obtained from patients without any medical treatment 12 hours before operation and 1st, 3rd, and 5th days postoperatively. Plasma presepsin levels, along with white blood counts (WBC, leukocyte), C-reaktive protein (CRP) and Neutrophil-Lymphocyte Ratio (NLR), were evaluated in patients who had sleeve gastrectomy line leakage.
Results:
In cases with complications, postoperative leukocyte count, CRP, NLR and presepsin measurements on the 1., 3. and 5. day were found higher than the group without complications. The predictive level of presepsin (p=0.006), CRP (p=0.023) and NLR (p=0.035) was found significantly higher than leukocyte (p<0.05).
Conclusions:
Our study indicates a role of presepsin levels in the detection and follow up of stapler line leaks following LSG. Increased levels of presepsin, especially on the first day of surgery, may play an important role for early detection of possible postoperative complications without clinical reflection.
Keywords:
Laparoscopic sleeve gastrectomy, morbid obesity, presepsin, stapler line leaks
References
1
Gagner M, Rogula T. Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg. 2003;13:649-54.
2
Jurowich C, Thalheimer A, Seyfried F, Fein M, Bender G, Germer CT, et al. Gastric leakage after sleeve gastrectomy-clinical presentation and therapeutic options. Langenbecks Arch Surg. 2011;396:981-7.
3
de Aretxabala X, Leon J, Wiedmaier G, Turu I, Ovalle C, Maluenda F, et al. Gastric leak after sleeve gastrectomy: analysis of its management. Obes Surg. 2011;21:1232-7.
4
Csendes A, Braghetto I, León P, Burgos AM. Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity. J Gastrointest Surg. 2010;14:1343-8.
5
Jurowich C, Thalheimer A, Seyfried F, Fein M, Bender G, Germer CT, et al. Gastric leakage after sleeve gastrectomy-clinical presentation and therapeutic options. Langenbecks Arch Surg. 2011;396:981-7.
6
Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery. Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2010;6:1-5.
7
Alves A, Panis Y, Pocard M, Regimbeau JM, Valleur P. Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg. 1999;189:554-9.
8
Platell C, Barwood N, Dorfmann G, Makin G. The incidence of anastomotic leaks in patients undergoing colorectal surgery. Colorectal Dis. 2007;9:71-9.
9
de Aretxabala X, Leon J, Wiedmaier G, Turu I, Ovalle C, Maluenda F, Gonzalez C, Humphrey J, Hurtado M, Benavides C. Gastric leak after sleeve gastrectomy: analysis of its management. Obes Surg 2011;21:1232-7 [PMID: 21416198 DOI: 10.1007/s11695-011-0382-5]
10
Casella G, Soricelli E, Rizzello M, Trentino P, Fiocca F, Fantini A, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19:821-6.
11
Boccola MA, Buettner PG, Rozen WM, Siu SK, Stevenson AR, Stitz R, et al. Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients. World J Surg. 2011;35:186-95.
12
Lipska MA, Bissett IP, Parry BR, Merrie AE. Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg. 2006;76:579-85.
13
Stamou KM, Menenakos E, Dardamanis D, Arabatzi C, Alevizos L, Albanopoulos K, et al. Prospective comparative study of the efficacy of staple-line reinforcement in laparoscopic sleeve gastrectomy. Surg Endosc. 2011;25:3526-30.
14
Sakran N, Goitein D, Raziel A, Keidar A, Beglaibter N, Grinbaum R, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27:240-5.
15
Yaegashi Y, Shirakawa K, Sato N, Suzuki Y, Kojika M, Imai S, et al. Evaluation of a newly identified soluble CD14 subtype as a marker for sepsis. J Infect Chemother. 2005;11:234-8.
16
Palmiere C, Mussap M, Bardy D, Cibecchini F, Mangin P. Diagnostic value of soluble CD14 subtype (sCD14-ST) presepsin for the postmortem diagnosis of sepsis-related fatalities. Int J Legal Med. 2013;127:799-808.
17
Liu B, Chen YX, Yin Q, Zhao YZ, Li CS. Diagnostic value and prognostic evaluation of Presepsin for sepsis in an emergency department. Crit Care. 2013;17:R244.
18
Ulla M, Pizzolato E, Lucchiari M, Loiacono M, Soardo F, Forno D, et al. Diagnostic and prognostic value of presepsin in the management of sepsis in the emergency department: a multicenter prospective study. Crit Care. 2013;17:R168.
19
Hyman NH. Managing anastomotic leaks from intestinal anastomoses. Surgeon. 2009;7:31-5.
20
Murrell ZA, Stamos MJ. Reoperation for anastomotic failure. Clin Colon Rectal Surg. 2006;19:213-6.
21
Spanuth E, Ebelt H, Ivandic B, Werdan K. Diagnostic and prognostic value of soluble CD14 subtype (sCD14-ST) in emergency patients with early sepsis using the new assay PATHFAST Presepsin. 21st International Congress of Clinical Chemistry and Laboratory Medicine, IFCC-WorldLab-EuroMedLab. Berlin. 2011.
22
Lalor PF, Tucker ON, Szomstein S, Rosenthal RJ. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2008;4:33-8.
23
Gonzalez R, Sarr MG, Smith CD, Baghai M, Kendrick M, Szomstein S. et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg. 2007;204:47-55.
24
Vix M, Diana M, Marx L, Callari C, Wu HS, Perretta S, Mutter D, Marescaux J. et al. Management of staple line leaks after sleeve gastrectomy in a consecutive series of 378 patients. Surg Laparosc Endosc Percutan Tech. 2015;25:89-93.
25
Carucci LR1, Turner MA, Conklin RC, DeMaria EJ, Kellum JM, Sugerman HJ. Roux-en-Y gastric bypass surgery for morbid obesity: evaluation of postoperative extraluminal leaks with upper gastrointestinal series. Radiology. 2006;238:119-27.
26
Walsh C, Karmali S. Endoscopic management of bariatric complications: A review and update. World J Gastrointest Endosc. 2015;7:518-23.
27
Platt JJ, Ramanathan ML, Crosbie RA, Anderson JH, McKee RF, Horgan PG, et al. C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol. 2012;19:4168-77.
28
Prajapati JH, Sahoo S, Nikam T, Shah KH, Maheriya B, Parmar M. Association of high density lipoprotein with platelet to lymphocyte and neutrophil to lymphocyte ratios in coronary artery disease patients. J Lipids. 2014;2014:686791.
29
Chen ZY, Raghav K, Lieu CH, Jiang ZQ, Eng C, Vauthey JN, et al. Cytokine profile and prognostic significance of high neutrophil-lymphocyte ratio in colorectal cancer. Br J Cancer. 2015;112:1088-97.
30
Shimizu T, Ishizuka M, Kubota K. A lower neutrophil to lymphocyte ratio is closely associated with catarrhal appendicitis versus severe appendicitis. Surg Today. 2016;46:84-89.
31
Kahramanca S, Ozgehan G, Seker D, Gökce EI, Seker G, Tunç G, et al. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2014;20:19-22.
32
Sargentini V, Ceccarelli G, D’Alessandro M, Collepardo D, Morelli A, D’Egidio A, et al. Presepsin as a potential marker for bacterial infection relapse in critical care patients. A preliminary study. Clin Chem Lab Med. 2015;53:567-73.
33
Zhang J, Hu ZD, Song J, Shao J. Diagnostic Value of Presepsin for Sepsis: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 2015;94:e2158.
34
Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg. 2002;26:499-502.
35
den Dulk M1, Noter SL, Hendriks ER, Brouwers MA, van der Vlies CH, Oostenbroek RJ, et al. Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Eur J Surg Oncol. 2009;35:420-6.