Diagnostic value of routine fluoroscopy after sleeve gastrectomy: Accuracy, cost, and clinical implications

Staple-line leakage remains one of the most serious complications of sleeve gastrectomy (SG). Although routine postoperative fluoroscopy is commonly performed to detect leaks, its true diagnostic and clinical value remains controversial. This study aimed to assess the diagnostic accuracy, clinical outcomes, and cost implications of routine fluoroscopy compared to selective symptom-driven imaging after SG. This retrospective cohort study was conducted in the Department of General Surgery, Mersin City Training and Research Hospital and included 301 patients who underwent primary SG between January 2019 and December 2024. Patients were divided into 2 cohorts: those who underwent routine postoperative fluoroscopy (Group I, n = 268) and those managed with selective imaging based on clinical findings (Group II, n = 33). Computed tomography was used as the reference standard to confirm the leaks. Statistical analyses were performed using Statistical Package for the Social Sciences v25. Diagnostic indices, including sensitivity, specificity, predictive values, and receiver operating characteristic area under the curve, were calculated, and cost differences were analyzed. Baseline demographic and clinical characteristics were comparable between the groups. The leak rate was 0.7% in Group I and 3.0% in Group II (P = .751). Fluoroscopy demonstrated low sensitivity (37.5%), but high specificity (96.2%), and negative predictive value (98.3%), with a moderate receiver operating characteristic area under the curve of 0.67. Despite similar clinical outcomes, the fluoroscopy group incurred higher costs ($4100 ± 650 vs $3500 ± 540, P < .05). Our findings indicate that routine postoperative fluoroscopy after sleeve gastrectomy contributes minimally to diagnostic or clinical decision-making. While its specificity and negative predictive accuracy remain excellent, its limited sensitivity and additional cost reduce its overall value. Adopting a selective, symptom-oriented imaging strategy, supported by clinical evaluation and computed tomography, appears to be safer and more cost-effective. Future multicenter studies that combine clinical evaluation, imaging, and biomarkers may further improve early leak detection and help standardize postoperative care in bariatric surgery.