Obesity Surgery

, Volume 28, Issue 10, pp 3268–3275 | Cite as

The Clinical Outcome of Postoperative Invasive Fungal Infections Complicating Laparoscopic Sleeve Gastrectomy

  • Yoav Bichovsky
  • Leonid Koyfman
  • Michael Friger
  • Boris Kirshtein
  • Abraham Borer
  • Gilbert Sebbag
  • Dmitry Frank
  • Amit Frenkel
  • Jochanan G. Peiser
  • Moti Klein
  • Evgeni BrotfainEmail author
Original Contributions



Peritonitis is a major complication of bariatric surgery due to direct damage to the natural barriers to infection. Most such secondary peritoneal infections are caused by Gram-negative microorganisms; however, under certain conditions, Candida species can infect the peritoneal cavity following bariatric surgery.

Materials and Methods

We retrospectively analyzed the clinical and microbiological data of morbidly obese patients who suffered infectious complications following laparoscopic sleeve gastrectomy (LSG) at the Soroka Medical Center between January 2010 and June 2015.


Out of 800 patients who underwent LSG, 43 (5.3%( developed secondary peritonitis and were admitted to our General Intensive Care Unit during the study period. Intraperitoneal leaks, intraabdominal abscesses and pleural effusions were significantly more common in patients with fungal infection than in those with non-fungal infections (p values 0.027, < 0.001, and < 0.014, respectively). Leaks situated at the suture line of gastro-esophageal area occurred much more frequently in the fungal infection group than in the non-fungal infection group (94.7 vs 41.7%, p < 0.001). Microbiological analysis of the abdominal and pleural fluids of patients with invasive fungal infectious complications showed the presence of commensal polymicrobial bacterial infections—mainly Streptoccocus constellatus and coagulase negative Staphylococcus spp. Leakage at the suture line of gastro-esophageal area (upper suture part) and administration of parenteral nutrition were found to be independent predictors for invasive fungal infections after LSG.


Our study demonstrates that invasive fungal infection is a significant postoperative infectious complication of bariatric LSG surgery in morbidly obese patients.


Sleeve gastrectomy Invasive fungal infection Obesity Critical care 


Compliance with Ethical Standards

The study was reviewed and approved by the SUMC Human Research and Ethics Committee (RN 0334-15-SOR).

Conflict of Interests

The authors declare that they have no competing interests.

This research has not been funded please state the following. This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Statement of Informed Consent

Informed consent was not needed to obtain because of retrospective design of the study.


  1. 1.
    Rebibo L, Fuks D, Verhaeghe P, et al. Repeat sleeve gastrectomy compared with primary sleeve gastrectomy: a single-center, matched case study. Obes Surg. 2012;22:1909–15.CrossRefPubMedGoogle Scholar
  2. 2.
    Marceau P, Biron S, Bourque RA, et al. Biliopancreatic diversion with a new type of gastrectomy. Obes Surg. 1993;3:29–35.CrossRefPubMedGoogle Scholar
  3. 3.
    Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG), New York City. Obes Surg. 2008;18:487–96.CrossRefPubMedGoogle Scholar
  4. 4.
    Gagner M, Deitel M, Kalberer TL, et al. The second international consensus summit for sleeve gastrectomy. Surg Obes Relat Dis. 2009;5:476–85.CrossRefPubMedGoogle Scholar
  5. 5.
    Montravers P, Guglielminiotti J, Zappella N, et al. Clinical features and outcome of postoperative peritonitis following bariatric surgery. Obes Surg. 2013;23:1536–44.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Carneiro HA, Mavrakis A, Mylonakis E. Candida peritonitis: an update on the latest research and treatments. World J Surg. 2011;35:2650–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Sawyer RG, Rosenlof LK, Adams RB, et al. Peritonitis into the 1990s: changing pathogens and changing strategies in the critically ill. Am Surg. 1992;58:82–7.PubMedGoogle Scholar
  8. 8.
    Johnson DW, Cobb JP. Candida infection and colonization in critically ill surgical patients. Virulence. 2010;1:355–6.CrossRefPubMedGoogle Scholar
  9. 9.
  10. 10.
    Moskowicz D, Arienzo R, Khettab I, et al. Sleeve gastrectomy severe complications: it is always a reasonable surgical option? Obes Surg. 2013;23:676–86.CrossRefGoogle Scholar
  11. 11.
    Deitel M, Gagner M, Erikson AL, et al. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:749–59.CrossRefPubMedGoogle Scholar
  12. 12.
    D'Hondt M, Vanneste S, Pottel H, et al. Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance and 6-year weight loss. Surg Endosc. 2011;25:2498–504.CrossRefPubMedGoogle Scholar
  13. 13.
    Lamme B, Van Ruler O, Boermeester MA. Surgical re-intervention in postoperative peritonitis based on longitudinal scoring systems. Intensive Care Med. 2002;28:1673–4.CrossRefPubMedGoogle Scholar
  14. 14.
    De Ruiter J, Weel J, Manusama E, et al. The epidemiology of intra-abdominal flora in critically ill patients with secondary and tertiary abdominal sepsis. Infection. 2009;37:522–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Bassetti M, Marchetti M, Chakrabarti A, et al. A research agenda on the management of intra-abdominal candidiasis: results from a consensus of multinational experts. Intensive Care Med. 2013;39:2092–106.CrossRefPubMedGoogle Scholar
  16. 16.
    Lee SC, Fung CP, Chen HY, et al. Candida peritonitis due to peptic ulcer perforation: incidence rate, risk factors, prognosis and susceptibility to fluconazole and amphotericin B. Diagn Microbiol Infect Dis. 2002;44:23–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Yoav Bichovsky
    • 1
  • Leonid Koyfman
    • 1
  • Michael Friger
    • 2
  • Boris Kirshtein
    • 3
  • Abraham Borer
    • 4
  • Gilbert Sebbag
    • 5
  • Dmitry Frank
    • 1
  • Amit Frenkel
    • 1
  • Jochanan G. Peiser
    • 6
  • Moti Klein
    • 1
  • Evgeni Brotfain
    • 1
    Email author
  1. 1.Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical CenterBen-Gurion University of the NegevBeer-ShevaIsrael
  2. 2.Health Science FacultyBen-Gurion University of the NegevBeer-ShevaIsrael
  3. 3.Department of General Surgery A, Soroka Medical CenterBen-Gurion University of the NegevBeer-ShevaIsrael
  4. 4.Department of Infectious Diseases, Soroka Medical CenterBen-Gurion University of the NegevBeer-ShevaIsrael
  5. 5.Department of General Surgery B, Soroka Medical CenterBen-Gurion University of the NegevBeer-ShevaIsrael
  6. 6.Department of Medical Management, Soroka Medical CenterBen-Gurion University of the NegevBeer-ShevaIsrael

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