Diagnostic value of computed tomography for detecting anastomotic or staple line leakage after bariatric surgery

Marianne C. Kalff, Christel A. L. de Raaff, Claire E. E. de Vries, Usha K. Coblijn, Meta Tjeenk Willink, Janneke M. B. Fauquenot-Nollen, Sebastiaan Jensch, Steve M. M. de Castro, Ruben N. van Veen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Postbariatric anastomotic or staple line leakage (ASLL) is a dreaded complication with an incidence up to 1.6% and a leak-associated mortality of 5.0% to 16.7%. Feared low sensitivity of abdominal computed tomography (CT) for detecting ASLL is causing surgeons to omit CT and directly perform a diagnostic laparoscopy in patients with suspected ASLL. Objectives: To evaluate the diagnostic value of CT in case of suspected ASLL after bariatric procedures and to identify reliable CT characteristics predicting the presence of ASLL. Setting: A large teaching hospital and bariatric center of excellence. Methods: All CT scans performed for suspected ASLL after bariatric surgery in the period November 2007 until August 2016 were independently reevaluated by abdominal radiologists. The diagnostic value of CT by means of sensitivity, specificity, and positive and negative predictive value was analyzed comparing results of reevaluation to a standard of reference. Multivariable regression was performed to identify reliable CT characteristics for the presence of ASLL. Results: A total of 66 CT scans were performed because of suspected leakage. Reevaluation of CT scans revealed a sensitivity of 89% to 100%, a specificity of 69% to 78%, a positive predictive value of 39% to 50%, and a negative predictive value of 97% to 100% of CT for detecting ASLL after bariatric surgery. Multivariable logistic regression of ASLL characteristics on CT revealed ‘air near the anastomosis/staple line’ as the only independent predictor for the presence of ASLL. Conclusion: With a sensitivity of 89% to 100% and negative predictive value of 97% to 100%, a negative CT can rule out ASLL in patients with a lower suspicion of ASLL.
Original languageEnglish
Pages (from-to)1310-1316
JournalSurgery for Obesity and Related Diseases
Volume14
Issue number9
DOIs
Publication statusPublished - 2018

Cite this

Kalff, Marianne C. ; de Raaff, Christel A. L. ; de Vries, Claire E. E. ; Coblijn, Usha K. ; Willink, Meta Tjeenk ; Fauquenot-Nollen, Janneke M. B. ; Jensch, Sebastiaan ; de Castro, Steve M. M. ; van Veen, Ruben N. / Diagnostic value of computed tomography for detecting anastomotic or staple line leakage after bariatric surgery. In: Surgery for Obesity and Related Diseases. 2018 ; Vol. 14, No. 9. pp. 1310-1316.
@article{7587b3176aeb4ea8a2ed35792b02eafa,
title = "Diagnostic value of computed tomography for detecting anastomotic or staple line leakage after bariatric surgery",
abstract = "Background: Postbariatric anastomotic or staple line leakage (ASLL) is a dreaded complication with an incidence up to 1.6{\%} and a leak-associated mortality of 5.0{\%} to 16.7{\%}. Feared low sensitivity of abdominal computed tomography (CT) for detecting ASLL is causing surgeons to omit CT and directly perform a diagnostic laparoscopy in patients with suspected ASLL. Objectives: To evaluate the diagnostic value of CT in case of suspected ASLL after bariatric procedures and to identify reliable CT characteristics predicting the presence of ASLL. Setting: A large teaching hospital and bariatric center of excellence. Methods: All CT scans performed for suspected ASLL after bariatric surgery in the period November 2007 until August 2016 were independently reevaluated by abdominal radiologists. The diagnostic value of CT by means of sensitivity, specificity, and positive and negative predictive value was analyzed comparing results of reevaluation to a standard of reference. Multivariable regression was performed to identify reliable CT characteristics for the presence of ASLL. Results: A total of 66 CT scans were performed because of suspected leakage. Reevaluation of CT scans revealed a sensitivity of 89{\%} to 100{\%}, a specificity of 69{\%} to 78{\%}, a positive predictive value of 39{\%} to 50{\%}, and a negative predictive value of 97{\%} to 100{\%} of CT for detecting ASLL after bariatric surgery. Multivariable logistic regression of ASLL characteristics on CT revealed ‘air near the anastomosis/staple line’ as the only independent predictor for the presence of ASLL. Conclusion: With a sensitivity of 89{\%} to 100{\%} and negative predictive value of 97{\%} to 100{\%}, a negative CT can rule out ASLL in patients with a lower suspicion of ASLL.",
author = "Kalff, {Marianne C.} and {de Raaff}, {Christel A. L.} and {de Vries}, {Claire E. E.} and Coblijn, {Usha K.} and Willink, {Meta Tjeenk} and Fauquenot-Nollen, {Janneke M. B.} and Sebastiaan Jensch and {de Castro}, {Steve M. M.} and {van Veen}, {Ruben N.}",
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Diagnostic value of computed tomography for detecting anastomotic or staple line leakage after bariatric surgery. / Kalff, Marianne C.; de Raaff, Christel A. L.; de Vries, Claire E. E.; Coblijn, Usha K.; Willink, Meta Tjeenk; Fauquenot-Nollen, Janneke M. B.; Jensch, Sebastiaan; de Castro, Steve M. M.; van Veen, Ruben N.

In: Surgery for Obesity and Related Diseases, Vol. 14, No. 9, 2018, p. 1310-1316.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Diagnostic value of computed tomography for detecting anastomotic or staple line leakage after bariatric surgery

AU - Kalff, Marianne C.

AU - de Raaff, Christel A. L.

AU - de Vries, Claire E. E.

AU - Coblijn, Usha K.

AU - Willink, Meta Tjeenk

AU - Fauquenot-Nollen, Janneke M. B.

AU - Jensch, Sebastiaan

AU - de Castro, Steve M. M.

AU - van Veen, Ruben N.

PY - 2018

Y1 - 2018

N2 - Background: Postbariatric anastomotic or staple line leakage (ASLL) is a dreaded complication with an incidence up to 1.6% and a leak-associated mortality of 5.0% to 16.7%. Feared low sensitivity of abdominal computed tomography (CT) for detecting ASLL is causing surgeons to omit CT and directly perform a diagnostic laparoscopy in patients with suspected ASLL. Objectives: To evaluate the diagnostic value of CT in case of suspected ASLL after bariatric procedures and to identify reliable CT characteristics predicting the presence of ASLL. Setting: A large teaching hospital and bariatric center of excellence. Methods: All CT scans performed for suspected ASLL after bariatric surgery in the period November 2007 until August 2016 were independently reevaluated by abdominal radiologists. The diagnostic value of CT by means of sensitivity, specificity, and positive and negative predictive value was analyzed comparing results of reevaluation to a standard of reference. Multivariable regression was performed to identify reliable CT characteristics for the presence of ASLL. Results: A total of 66 CT scans were performed because of suspected leakage. Reevaluation of CT scans revealed a sensitivity of 89% to 100%, a specificity of 69% to 78%, a positive predictive value of 39% to 50%, and a negative predictive value of 97% to 100% of CT for detecting ASLL after bariatric surgery. Multivariable logistic regression of ASLL characteristics on CT revealed ‘air near the anastomosis/staple line’ as the only independent predictor for the presence of ASLL. Conclusion: With a sensitivity of 89% to 100% and negative predictive value of 97% to 100%, a negative CT can rule out ASLL in patients with a lower suspicion of ASLL.

AB - Background: Postbariatric anastomotic or staple line leakage (ASLL) is a dreaded complication with an incidence up to 1.6% and a leak-associated mortality of 5.0% to 16.7%. Feared low sensitivity of abdominal computed tomography (CT) for detecting ASLL is causing surgeons to omit CT and directly perform a diagnostic laparoscopy in patients with suspected ASLL. Objectives: To evaluate the diagnostic value of CT in case of suspected ASLL after bariatric procedures and to identify reliable CT characteristics predicting the presence of ASLL. Setting: A large teaching hospital and bariatric center of excellence. Methods: All CT scans performed for suspected ASLL after bariatric surgery in the period November 2007 until August 2016 were independently reevaluated by abdominal radiologists. The diagnostic value of CT by means of sensitivity, specificity, and positive and negative predictive value was analyzed comparing results of reevaluation to a standard of reference. Multivariable regression was performed to identify reliable CT characteristics for the presence of ASLL. Results: A total of 66 CT scans were performed because of suspected leakage. Reevaluation of CT scans revealed a sensitivity of 89% to 100%, a specificity of 69% to 78%, a positive predictive value of 39% to 50%, and a negative predictive value of 97% to 100% of CT for detecting ASLL after bariatric surgery. Multivariable logistic regression of ASLL characteristics on CT revealed ‘air near the anastomosis/staple line’ as the only independent predictor for the presence of ASLL. Conclusion: With a sensitivity of 89% to 100% and negative predictive value of 97% to 100%, a negative CT can rule out ASLL in patients with a lower suspicion of ASLL.

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U2 - 10.1016/j.soard.2018.05.007

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