Staple line and anastomotic leakage is frequent and threatening complication of bariatric surgery. Its early diagnostics is difficult, and search for new diagnostic criteria is necessary.

Objective. To improve post-bariatric staple line and anastomotic leakage diagnostics by revealing new early diagnostic criteria.

Materials and methods. Following hypothesis considered: postoperative stab neutrophils level is early sign of staple line and anastomotic leakage after bariatric surgery. Retrospective comparative study performed to test the hypothesis. Study group consisted of patients with staple line and anastomotic leakage in postoperative period (n = 9). Control group consisted of patients with uncomplicated postoperative period (n = 253). ROC-curves for stab neutrophils levels in 12 and 36 hours after surgery analyzed in both groups. The reference method was a comprehensive dynamic examination.

Results. Area under the ROC-curve for stab neutrophils in 36 hours (AUC = 0,613) was higher, than area under ROC-curve for stab neutrophils in 12 hours (AUC = 0,543). So stab neutrophils in 36 hours is more sensitive and specific early diagnostic criterion for staple line and anastomotic leakage. Sensitivity Se = 55,56% and specificity Sp = 72,13% achieved at the stab neutrophils in 36 hours after surgery level above 9%.

Conclusion. As staple line and anastomotic leakage early diagnostic criterion stab neutrophils level in 36 hours after bariatric surgery has high specificity. Proposed criterion available in early postoperative period, when signs of leakage are obscured. In combination with other methods it promotes staple line and anastomotic leakage earlier diagnostics, what improve patients’ treatment results.

1. Bariatric surgery: a systematic review and network meta-analysis of randomized trials / R. Padwal [et al.] // Obesity Reviews. – 2011. – Vol. 12, – № 8. – P. 602–621.

2. Diagnosis and management of the postoperative surgical and medical complications of bariatric surgery / P. Montravers [et al.] // Anaesthesia Critical Care & Pain Medicine. – 2015. – Vol. 34, – № 1. – P. 45–52.

3. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients / N. Sakran [et al.] // Surgical Endoscopy. – 2013. –Vol. 27, – № 1. – P. 240–245.

4. IFSO Global Registry Report / J. Himpens [et al.]. – Henley-on-Thames: Dendrite Clinical Systems Ltd, 2018. – 84 p.

5. Late Complication of Laparoscopic Sleeve Gastrectomy / A. Dakwar [et al.] // Case Reports in Gastrointestinal Medicine. – 2013. – Vol. 2013. – P. 1–5.

6. Management of Leaks After Laparoscopic Sleeve Gastrectomy in Patients with Obesity / A. Csendes [et al.] // Journal of Gastrointestinal Surgery. – 2010. – Vol. 14, – № 9. – P. 1343–1348.

7. Management von komplikationen nach adipositaschirurgie / B. Wölnerhanssen [et al.] // Der Chirurg. – 2015. – Vol. 86, – № 12. – P. 1114–1120.

8. One Thousand Consecutive Mini-Gastric Bypass: Short- and Long-term Outcome / R. Noun [et al.] // Obesity Surgery. – 2012. – Vol. 22, – № 5. – P. 697–703.

9. Revisional Surgery After Sleeve Gastrectomy / A. Lacy [et al.] // Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. – 2010. – Vol. 20, – № 5. – P. 351–356.

10. Treatment of Obesity: Weight Loss and Bariatric Surgery / B. M. Wolfe [et al.] // Circulation Research. – 2016. – Vol. 118, – № 11. – P. 1844–1855.