Dynamic ultrasound monitoring of intraperitoneal effusion for predicting complications after laparoscopic gastrectomy

Abstract

BACKGROUND

Transabdominal ultrasound monitoring can predict the occurrence of intraperitoneal effusion after laparoscopic gastrectomy and provide data reference for early intervention for postoperative complications.

AIM

To investigate dynamic monitoring of intraperitoneal effusion after laparoscopic gastrectomy and correlation with prognosis to guide intervention for postoperative complications.

METHODS

Eighty patients who underwent laparoscopic gastric cancer surgery in a general surgery department over four years was selected. Standardized transabdominal ultrasonography was performed on 1^st, 3^rd and 7^th day after surgery. The incidence and nature of the effusion and inflammatory indicators were measured simultaneously. Intraperitoneal effusion risk was analyzed using the generalized estimating equation, linear mixed model was used to evaluate the factors influencing effusion collection, and Cox regression and receiver operating characteristic curves were used to evaluate the effectiveness of complication prediction.

RESULTS

The incidence of intraperitoneal effusion peaked on the 3^rd postoperative day (52.50%, 42/80). Subgroup analysis showed a higher risk of fluid accumulation after total gastrectomy. The risk of intraperitoneal effusion after total gastrectomy was 2.10 times that of distal gastrectomy [odds ratio = 2.10, 95% confidence interval (CI): 1.14-3.87] and the risk of diabetes mellitus was increased by 85% (odds ratio = 1.85, 95%CI: 1.04-3.31). The complication risk of mixed effusion increased 3.86 times (hazard ratio = 3.86, 95%CI: 1.62-9.18), and the total complication rate reached 53.57% (15/28). Procalcitonin > 0.47 ng/mL on day 3 was the best predictor of infectious complications (area under the curve = 0.874, sensitivity: 82.9%, specificity: 81.7%), followed by C-reactive protein > 48.5 mg/L (area under the curve = 0.852). There was no significant difference in outcomes between the age subgroups.

CONCLUSION

Transabdominal ultrasonography accurately captures the evolution of effusion after laparoscopic gastrectomy. It is recommended that high-risk patients undergo focused ultrasonographic at 72 hours postoperatively to facilitate early intervention.

Keywords: Transabdominal ultrasound monitoring; Laparoscopic gastrectomy; Dynamic evolution of intraperitoneal effusion; Mixed effusion; Gastric cancer surgery

Core Tip: Dynamic transabdominal ultrasound monitoring provides an effective, noninvasive approach to assess the evolution of intraperitoneal effusion after laparoscopic gastrectomy. This study demonstrates that ultrasound-detected mixed effusion and elevated inflammatory markers, particularly procalcitonin on postoperative day 3, are strong predictors of infectious complications. Focused ultrasonography within 72 hours after surgery allows for timely detection and intervention, improving prognosis and reducing postoperative morbidity. Incorporating routine ultrasound monitoring into perioperative management may optimize clinical decision-making and enhance recovery in gastric cancer surgery patients.