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Page 2 of 7 Kheirvari et al. Mini-invasive Surg 2020;4:3 I http://dx.doi.org/10.20517/2574-1225.2019.45

INTRODUCTION
Bariatric surgery has become one of the most effective treatments for morbid obesity, with extremely good
long-term results on weight loss, co-morbidities, and low mortality as well as postoperative complications
[2]
[1]
rate . Bariatric surgery for morbid obesity has improved in the last fifteen years . According to every
published report, bariatric surgery is one of the safest operations with a complication rate of less than
[3,4]
1% . However, knowledge about its anatomic reconstruction, the physiologic effects of bariatric surgery,
and the prevention and management of complications after a bariatric procedure have not been directly
[5,6]
incorporated into general procedure preparation programs . Hence, general surgeons should expand
their basic anatomic, clinical, and surgical understanding because they might face postoperatively acute
[6]
or chronic complications in their patients . Bariatric surgery can cause early complications including
primarily staple-line leakage and bleeding in the immediate postoperative days. Late postoperative
complications include abscess development or delayed postoperative staple-line leakage with fistula as well
as sleeve stenosis. In addition, some patients can develop a rare case of sleeve gastrectomy, which is deep
[7]
vein thrombosis .
As mentioned, gastrointestinal staple-line leakage remains one of the most unavoidable complications after
[8]
the procedure, resulting in increased healthcare cost and postoperative pain in patients . According to
several meta-analyses, gastrointestinal leak rate has been estimated to range from 2.5% to 7% after various
[6-9]
types of bariatric surgery . Postoperative gastrointestinal leak has been constantly dropping recently and
[10]
its occurrence is low ; nonetheless, leakage is still a principal complication, leading to increase morbidity
and mortality rate. Various surgeons have employed different interventions for detecting leaks either
intraoperatively or postoperatively such as placement of an orogastric tube with distention of the gastric
[6]
pouch with air, endoscopy with carbon dioxide insufflations, and methylene blue dye .

Researchers have recently found that, in patients with low BMI, postoperative increased heart rate
(tachycardia > 120 bpm), evidence of respiratory distress, and decreased hemoglobin were significantly
[13]
associated with bleeding [11,12] . Alizadeh et al. reported that oxygen dependency, hypoalbumenia, sleep
[13]
apnea, hypertension, and diabetes were critical factors related to increased risk of leak . In addition,
preoperative platelet count, INR, and systolic blood pressure were not significantly related to postoperative
[12]
bleeding . On the other side, the association between preoperative partial thromboplastin time and
[11]
[12]
bleeding was significant . Burgos et al. stated that increased white blood cell (WBC) and C-reactive
protein (CRP) levels, abdominal pain, tachycardia, tachypnea, and fever are more common in subjects
[11]
with gastric leak .
From the clinical perspective, an erythrocyte sedimentation rate (ESR) is one of the blood tests that is
usually ordered by physicians for patients with symptoms such as inflammation in the body, headaches,
fever, joint stiffness, neck or shoulder pain, weight loss, loss of appetite, anemia, and fever [14,15] .

Higher ESR levels may be associated with a medical condition, such as infection or inflammation
(especially inflammatory bowel disease), rheumatoid arthritis, cardiovascular or kidney disease, and some
types of cancers. Higher ESR levels do not necessarily mean that the patients have a medical condition
[15]
that requires treatment . For example, certain medications and dietary supplements can also affect ESR
results, including oral contraceptives, cortisone, vitamin A, and aspirin. A moderate ESR may indicate
pregnancy, menstruation, or anemia, rather than an inflammatory disease. A slow ESR may indicate a
blood disorder such as polycythemia, sickle cell anemia, and leukocytosis [14,15] .

The main purpose of this study was to evaluate correlations of ESR, CRP, and platelet count with incidence
of intermediate gastrointestinal leak in obese subjects who underwent sleeve gastrectomy.