The relation between excess visceral fat as measured by multidetector computed tomography and early postoperative complications following sleeve gastrectomy

Abstract Background Body mass index (BMI) is widely used for assessing obesity, yet it does not reflect body fat distribution. Visceral fat area (VFA), particularly when measured via computed tomography (CT), is a more precise indicator of metabolic risk and may be associated with increased perioperative morbidity. This study aimed to evaluate the feasibility of CT-assessed VFA in predicting early postoperative complications following sleeve gastrectomy. Methods This nested case–control study was conducted within a prospective cohort of patients undergoing primary laparoscopic sleeve gastrectomy between May 2023 and May 2024. All patients routinely underwent preoperative non-contrast abdominal CT. All patients who developed early postoperative complications (Clavien–Dindo ≥ II) within 30 days were included as cases, and consecutive uncomplicated patients from the same period served as controls. VFA was measured at the L3 level. Results Seventy-eight patients were included: 20 with complications and 58 without, reflecting the intentional case-enriched design. Patients with complications demonstrated significantly higher VFA compared with controls (212.1 cm 2 vs 160.9 cm 2 , p = 0.009). VFA showed a moderate correlation with BMI ( r = 0.41, p < 0.001), with some lower-BMI patients exhibiting disproportionately high VFA. Using ROC analysis, VFA predicted early postoperative complications with a sensitivity of 70% and a specificity of 74.1%. Conclusion Preoperative CT-measured VFA is significantly associated with early postoperative complications after sleeve gastrectomy and may serve as a valuable tool for preoperative risk stratification. The complication proportions in this cohort reflect the nested case–control design and should not be interpreted as population incidence.