Adjustable laparoscopic gastric banding: demonstrated on multidetector computed tomography with multiplanar reformation and 3-dimensional imaging

Changes in Gastric Volume and Their Implications for Weight Loss after Laparoscopic Sleeve Gastrectomy

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is a relatively new surgical technique for the treatment of morbid obesity. It is unclear whether the volume of the gastric remnant can expand after surgery as a result of intraluminal pressure maintained over time. If this were the case, the increased volume could affect weight loss and the improvement in comorbidities. This study aims to assess the evolution of residual gastric volume (RGV) during the first year after LSG and its relationship with weight loss.

MATERIAL AND METHODS

We conducted a prospective study of 112 patients who underwent LSG from February 2009 to December 2013. In order to measure the RGV after surgery, all patients were evaluated radiologically by an esophagogastroduodenal (EGD) transit at 1 and 12 postoperative months.

RESULTS

All patients showed a significant reduction in BMI compared with the preoperative measurement (33.48 ± 5.78 vs. 50.54 ± 6.69 kg/m²; p < 0.001). Increased RGV was observed when comparing the results obtained by EGD transit at 1 (68.39 ± 25.89 cm³) and 12 postoperative months (122.58 ± 38.76 cm³; p < 0.001). There was no association between increase in gastric volume and weight loss at 1-year follow-up (r = 0.01; p = 0.910).

CONCLUSIONS

The volume of the gastric remnant increased significantly during the first year after LSG. However, this increase was not associated with weight loss. Further prospective research with longer follow-up periods is needed to confirm or contrast the present results.

3D gastric computed tomography as a new imaging in patients with failure or complication after bariatric surgery

The number of bariatric operations performed each year is increasing. As a result, a rising number of patients in possible need for revisional surgery are referred to bariatric surgeons. But the standard methods of evaluation are often insufficient, and the best strategy remains difficult to choose. In our centre, we have developed 3D gastric computed tomography with air (3D-GCT). The aim of this pilot study was to assess the usefulness of this new image modality as an aid in the decision-making process in patients with failure or complications after bariatric surgery. Twenty patients referred for failure or complications after various bariatric procedures were included in the study. 3D-GCT was performed on a multidetector CT scanner after absorption of effervescent salt diluted in 10 ml of water and IV injection of butylscopolamine. Thin-slice data were transferred to a dedicated 3D workstation creating three-dimensional volume-rendering images of the oesophagus, gastric cavities and anastomoses. The volume of the gastric pouches and the diameter of stoma or anastomoses were measured. No failure or complications were observed. In all patients, 3D-GCT resulted in very impressive precise 3D images of post-surgical anatomy of the stomach. Imaging findings allowed us to identify or to eliminate the common complications of each procedure with a good accuracy, resulting in an aid to choose the best strategy in each patient. In conclusion, our pilot study suggests that 3D-GCT is useful as a decision-making aid in patients with failure or complications after bariatric surgery.