Background

Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure in the world. In an attempt to reduce the morbidity of a staple line leak, many surgeons place intraoperative drains (IOD) or perform postoperative imaging (POI). Several studies have demonstrated little or no benefit to these practices, yet there is no consensus on their utilization.

Methods

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was used to perform a retrospective study using data from LSG procedures performed between 2015 and 2018. Postoperative sepsis, septic shock, deep incisional surgical site infection (SSI), and organ/space SSI were used as markers of leak (MOLs). The impact of IOD and POI on the rate and timing of identification of these MOLs was analyzed with multivariate regression.

Results

There were 440,611 LSG procedures that met inclusion criteria, with 1,026 MOLs identified in 851 patients. Use of IODs (OR 1.564, p=<0.0001) and selective swallow study (OR 2.394, p<0.0001), but not routine swallow study (OR 1.032, p=0.6327), was significantly associated with increased incidence of identified MOLs. There was no significant difference in the time to identification of MOLs for IOD (11.45 vs. 11.88 days, p=0.5059) or POI (11.92 [routine] and 9.09 [selective] vs. 11.83 days, p=0.2347).

Conclusions

Patients with IODs and selective POI were more likely to have a marker of leak identified following LSG. The presence of these adjuncts may allow for increased identification of staple line leak, but do not appear to play a role in earlier identification.