Comparison of the postoperative outcome with and without intraoperative leak testing for sleeve gastrectomy: a systematic review and meta-analysis of 469,588 cases

Abstract

Objective: Postoperative staple line leakage after sleeve gastrectomy is a rare but serious complication. Many surgeons routinely test anastomosis with an intraoperative leak test as part of the sleeve gastrectomy procedure. This meta-analysis aims to determine whether an intraoperative leak test plays a role in reducing the rate of postoperative staple line related complications in patients who underwent sleeve gastrectomy. Methods: We searched the PubMed, Web of science, the Cochrane Library and Clinical Trials.gov databases for clinical studies assessing the application of intraoperative leak test (IOLT) in sleeve gastrectomy. The primary endpoint was the development of postoperative staple line leakage. Secondary endpoints included the postoperative bleeding, 30 days mortality rates, and 30 days readmission rates. Results: Six studies totaling 469,588 patients met the inclusion criteria. Our review found that the Staple line leakage (SLL) rate was 0.38% (1,221/ 324,264) in the IOLT group and 0.31% (453/ 145,324) in the no intraoperative leak test (NIOLT) group. Postoperative staple line leakage decreased in the NIOLT group compared with the IOLT group (OR=1.27; 95%CI 1.14 to 1.42, P=0.000). Postoperative bleeding was fewer in the IOLT group than that in the NIOLT group (OR 0.79; 95% CI 0.72 to 0.87, P=0.000). There was no significant difference between the IOLT group and the NIOLT group regarding 30 days mortality rates and 30 days readmission rates (P＞0.05). Conclusion: IOLT was correlated with an increase in staple line leakage when included as a part of the sleeve gastrectomy procedure. However, IOLT was associated with a lower rate of postoperative bleeding. Thus, IOLT should be considered in sleeve gastrectomy in the situation of suspected postoperative bleeding.