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Khalil A, Gomez E, Gowda PC, Weinstein RM, Eberly HW, Prologo FJ, Birkholz JH, Sarwani NE, Friedberg E, Rogers AM, Weiss CR. Assessment of arterial supply to the stomach after bariatric surgery using multidetector CT arteriography. Abdom Radiol (NY) 2024:10.1007/s00261-024-04467-6. [PMID: 38951233 DOI: 10.1007/s00261-024-04467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/19/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE To describe residual arterial supply to the stomach after bariatric surgery via a systematic arterial-phase CT assessment approach that can aid in diagnosis and treatment of postoperative complications and facilitate planning for future procedures. METHODS Arterial-phase CT of 46 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at 3 academic institutions were retrospectively reviewed to assess patency of left gastric artery (LGA), right gastric artery (RGA), gastroepiploic artery (GEA), and left inferior phrenic artery (LIPA) and presence of gastric perforators. RESULTS In 25 RYGB and 21 SG patients, mean diameters were LGA 2.2 ± 0.4 mm, RGA 1.6 ± 0.5 mm, and GEA 1.7 ± 0.4 mm. On RYGB scans, all LGAs, RGAs, and 24/25 (96%) of GEAs were identified. Excellent to good patency was seen in 20/25 (80%) LGAs, 21/25 (84%) RGAs, and 23/24 (96%) GEAs. On SG scans, all LGAs, 18/21 (86%) of RGAs, and 20/21 (95%) GEAs were identified. Excellent to good patency was seen in 17/21 (81%) LGAs, 15/18 (83%) RGAs, and 20/20 (100%) GEAs. In terms of gastric perforators, LGA supply was seen on 23/25 (92%) of RYGB and 17/17 (100%) of SG scans. RGA supply was seen on 13/21 (62%) RYGB and 9/18 (50%) SG scans. GEA supply was seen on 19/23 (83%) RYGB scans. No gastric supply via GEA was seen on SG scans. CONCLUSION In this study, arterial supply to the stomach through the LGA was consistently identified in all RYGB and SG cases, indicating an uncomplicated surgical approach with regard to preserving the LGA. Dedicated CT angiography protocol or catheter-directed angiography is recommended for accurate and comprehensive assessment of the gastric blood supply, particularly before surgical re-intervention.
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Affiliation(s)
- Adham Khalil
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed Tower 7203, Baltimore, MD, 21287, USA
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Erin Gomez
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed Tower 7203, Baltimore, MD, 21287, USA
| | - Prateek C Gowda
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Frank J Prologo
- Department of Biology, University of Georgia, Athens, GA, USA
| | - James H Birkholz
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Nabeel E Sarwani
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Eric Friedberg
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ann M Rogers
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Clifford R Weiss
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed Tower 7203, Baltimore, MD, 21287, USA.
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2
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Dayma K, David A, Omer A, Abdel-Dayam H, Tawil A, Socci N, Ahmed L, Gilet A, Haddad D. Routine Upper Gastrointestinal Series Post-bariatric Surgery: Predictors, Usage, and Utility. Obes Surg 2024; 34:1552-1560. [PMID: 38564172 DOI: 10.1007/s11695-024-07125-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To investigate usage and utility of routine upper gastrointestinal (UGI) series in the immediate post-operative period to evaluate for leak and other complications. METHODS Single institution IRB-approved retrospective review of patients who underwent bariatric procedure between 01/08 and 12/12 with at least 6-month follow-up. RESULTS Out of 135 patients (23%) who underwent routine UGI imaging, 32% of patients were post-gastric bypass (127) versus 4% of sleeve gastrectomy (8). In patients post-gastric bypass, 22 were found with delayed contrast passage, 3 possible obstruction, 4 possible leak, and only 1 definite leak. In patients post-sleeve gastrectomy, 2 had delayed passage of contrast without evidence of a leak. No leak was identified in 443 patients (77%) who did not undergo imaging. The sensitivity and specificity of UGI series for the detection of leak in gastric bypass patients were 100% and 97%, respectively, and the positive and negative predictive values were 20% and 100%, respectively. On univariate and multivariate analysis, sleeve gastrectomy patients (OR 0.4 sleeve vs bypass; P < 0.01) and male patients (OR 0.4 M vs F; P 0.02) were less likely to undergo routine UGI series (OR 0.4 M vs F; P 0.02). CONCLUSION Routine UGI series may be of limited value for the detection of anastomotic leaks after gastric bypass or sleeve gastrectomy and patients should undergo routine imaging based on clinical parameters. Gastric bypass procedure and female gender were factors increasing the likelihood of routine post-operative UGI. Further larger scale analysis of this important topic is warranted.
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Affiliation(s)
- Ketan Dayma
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Aruna David
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA
| | - Adil Omer
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA
| | - Haneen Abdel-Dayam
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA
| | - Anan Tawil
- Department of Surgery, Harlem Hospital Center, New York, NY, 10037, USA
| | - Nicholas Socci
- Department of Bioinformatics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10021, USA
| | - Leaque Ahmed
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA
| | - Anthony Gilet
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA
- Department of Radiology, Westchester Medical Center, Westchester, NY, 10595, USA
| | - Dana Haddad
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA.
- School of Medicine, Mohammed Bin Rashid University, Dubai, United Arab Emirates.
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3
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Petrak A, McNabb EA, Nguyen BP, Kirkpatrick VE, Cassaro S. Seat Belt Injury and Efferent Loop Laceration Following a Single Anastomosis Duodenal Switch: A Case Report. Cureus 2024; 16:e61388. [PMID: 38947652 PMCID: PMC11214639 DOI: 10.7759/cureus.61388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Blunt abdominal trauma patients who have had prior bariatric procedures may present a diagnostic and therapeutic challenge. The single anastomosis duodenal-ileal bypass with sleeve (SADI-S) is a modified duodenal switch procedure that is relatively uncommon. This case report describes a patient who previously underwent a SADI-S for the management of obesity and subsequently sustained a seat belt injury in a motor vehicle collision resulting in a laceration of the efferent loop. The patient presented with symptoms of acute abdominal pain and was diagnosed through imaging studies. Prompt surgical intervention was performed with resection and primary anastomosis of the damaged section of the jejunum, and repair of a large mesenteric laceration. We discuss the importance of early recognition and intraoperative decision-making in the case of this patient concerning her SADI-S.
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Affiliation(s)
- Alex Petrak
- Department of Surgery, Kaweah Health Medical Center, Visalia, USA
| | - Emily A McNabb
- Department of Surgery, Kaweah Health Medical Center, Visalia, USA
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4
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O'Brien C, Murad V, Renton M. Up-to-date review into the evolving world of bariatric interventions: a guide for radiologists. Abdom Radiol (NY) 2024; 49:1007-1019. [PMID: 38329482 DOI: 10.1007/s00261-023-04137-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 02/09/2024]
Abstract
Obesity is a worldwide health concern leading to several chronic health problems and comorbidities. Its treatment requires a multidisciplinary approach where lifestyle changes are fundamental. Additionally, in the past decade, the use of different surgical procedures of various levels of complexity has grown, with the objective of reducing the gastric capacity, creating diversions, or a combination of both. The aim of this article is to review and illustrate the major types of bariatric surgical techniques, their normal post-surgical anatomy, and the possible associated complications, to aid the radiologist in their assessment and timely diagnosis.
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Affiliation(s)
- Ciara O'Brien
- Department of Medical Imaging, JDMI University Health Network, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. ciara.o'
| | - Vanessa Murad
- Department of Medical Imaging, JDMI University Health Network, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Mary Renton
- Department of Medical Imaging, JDMI University Health Network, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
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5
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Alrayes MS, Altawili MA, Alsuabie SM, Sindi AW, Alharbi KM, Alsalhi KM, Al Alawi RM, Ali ID, Nasser AN, Alabdulrahim JM, Alkhaldi MH, Alhudhaif HM, Alotaibi SA. Surgical Interventions for the Management of Obesity-Related Joint Pain: A Narrative Review. Cureus 2024; 16:e59082. [PMID: 38800150 PMCID: PMC11128294 DOI: 10.7759/cureus.59082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Obesity-related joint pain is a common and debilitating condition that significantly impacts the quality of life, primarily due to the excess weight straining the joints. This results in inflammation and degeneration, which can cause pain, stiffness, and difficulty moving. We aimed to comprehensively review the literature discussing surgical interventions for obesity-related joint pain. We searched across databases (PubMed, Scopus, and Cochrane Library) to identify studies published between 2000 and 2023 that assessed surgical interventions for obesity-related joint pain. This review highlights the complex interplay of mechanical, inflammatory, and metabolic factors contributing to joint pain in obese individuals, highlighting both surgical and non-surgical interventions. Non-surgical interventions include weight loss, exercise, physical therapy, and medications. Surgical interventions include bariatric surgery and joint replacement surgery. Bariatric surgery significantly reduces body weight and improves the quality of life outcomes; however, multiple studies have found no improvement or worsening of joint pain post-surgery. Total joint arthroplasty has demonstrated good improvement in pain and function outcomes based on recent meta-analyses, although risks of complications are higher in obese patients. The treatment choice for obesity-related joint pain depends on the individual patient's circumstances. Non-surgical interventions are usually the first line of treatment. However, if these interventions are not effective, surgical interventions may be an option.
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Affiliation(s)
| | | | | | - Ahmad W Sindi
- General Practice, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Kawkab M Alharbi
- Surgery, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | | | | | | | - Alrashed N Nasser
- General Practice, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | | | - Hamad M Alhudhaif
- General Practice, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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6
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Gaballah AH, Kazi IA, Zaheer A, Liu PS, Badawy M, Moshiri M, Ibrahim MK, Soliman M, Kimchi E, Elsayes KM. Imaging after Pancreatic Surgery: Expected Findings and Postoperative Complications. Radiographics 2024; 44:e230061. [PMID: 38060424 DOI: 10.1148/rg.230061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Pancreatic surgery is considered one of the most technically challenging surgical procedures, despite the evolution of modern techniques. Neoplasms remain the most common indication for pancreatic surgery, although inflammatory conditions may also prompt surgical evaluation. The choice of surgical procedure depends on the type and location of the pathologic finding because different parts of the pancreas have separate vascular supplies that may be shared by adjacent organs. The surgical approach could be conventional or minimally invasive (laparoscopic, endoscopic, or robotic assisted). Because of the anatomic complexity of the pancreatic bed, perioperative complications may be frequently encountered and commonly involve the pancreatic-biliary, vascular, lymphatic, or bowel systems, irrespective of the surgical technique used. Imaging plays an important role in the assessment of suspected postoperative complications, with CT considered the primary imaging modality, while MRI, digital subtraction angiography, and molecular imaging are considered ancillary diagnostic tools. Accurate diagnosis of postoperative complications requires a solid understanding of pancreatic anatomy, surgical indications, normal postoperative appearance, and expected postsurgical changes. The practicing radiologist should be familiar with the most common perioperative complications, such as anastomotic leak, abscess, and hemorrhage, and be able to differentiate these entities from normal anticipated postoperative changes such as seroma, edema and fat stranding at the surgical site, and perivascular soft-tissue thickening. In addition to evaluation of the primary operative fossa, imaging plays a fundamental role in assessment of the adjacent organ systems secondarily affected after pancreatic surgery, such as vascular, biliary, and enteric complications. Published under a CC BY 4.0 license. Test Your Knowledge questions are available in the supplemental material. See the invited commentary by Winslow in this issue.
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Affiliation(s)
- Ayman H Gaballah
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Irfan A Kazi
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Atif Zaheer
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Peter S Liu
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Mohamed Badawy
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Mariam Moshiri
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Mohamed K Ibrahim
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Moataz Soliman
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Eric Kimchi
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Khaled M Elsayes
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
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Elsherif SB, Sharma SK, Sharma S, Zulia Y, Kumar S, Sharma S. Acute incarcerated intrathoracic sleeve herniation after laparoscopic sleeve gastrectomy: an uncommon yet urgent complication-a comprehensive case report and literature review. Emerg Radiol 2023; 30:811-816. [PMID: 37934315 DOI: 10.1007/s10140-023-02182-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023]
Abstract
Laparoscopic sleeve gastrectomy (LSG) stands as one of the most frequently performed bariatric procedures in the USA. While hiatal hernia or intrathoracic migration of the staple line is frequently described as a chronic complication, this review article sheds light on the seldom-discussed acute presentation of this alarming complication. We present a compelling case of a young female who experienced sudden and intractable vomiting shortly after LSG. Utilizing a multidisciplinary approach, upper gastrointestinal imaging (UGI) and computed tomography (CT) scans unequivocally confirmed incarcerated intrathoracic migration of the gastric sleeve, necessitating immediate surgical intervention. Radiologists must be equipped with the knowledge to recognize subtle yet crucial imaging findings from UGI and CT scans to ensure timely intervention, thus mitigating the risks associated with this underreported acute complication of LSG and ultimately improving patient outcomes and safety.
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Affiliation(s)
- Sherif B Elsherif
- The Department of Radiology, The University of Florida College of Medicine, 2nd Floor, Clinical Center, 655 West 8th Street, C90, Jacksonville, FL, 33209, USA.
| | - Sunil K Sharma
- The Department of General Surgery, Ascension St. Vincent's Southside Hospital, Jacksonville, FL, USA
| | - Swati Sharma
- The Department of Radiology, The University of Florida College of Medicine, 2nd Floor, Clinical Center, 655 West 8th Street, C90, Jacksonville, FL, 33209, USA
| | - Yanni Zulia
- The Department of Radiology, The University of Florida College of Medicine, 2nd Floor, Clinical Center, 655 West 8th Street, C90, Jacksonville, FL, 33209, USA
| | - Sindhu Kumar
- The Department of Radiology, The University of Florida College of Medicine, 2nd Floor, Clinical Center, 655 West 8th Street, C90, Jacksonville, FL, 33209, USA
| | - Smita Sharma
- The Department of Radiology, The University of Florida College of Medicine, 2nd Floor, Clinical Center, 655 West 8th Street, C90, Jacksonville, FL, 33209, USA
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8
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Bohlmann I, Müller W, Schuster A, Falch C. Redo Laparoscopic Gastric Bypass in a Patient with Intestinal Malrotation: Report of a Case and Video Vignette. Obes Surg 2023; 33:2620-2624. [PMID: 37402890 DOI: 10.1007/s11695-023-06694-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 07/06/2023]
Abstract
Unknown intestinal rotation anomaly poses a challenge in laparoscopic gastric bypass surgery. We present a case of a patient with intestinal non-rotation that stayed undetected throughout performing a laparoscopic Roux-en-Y gastric bypass. As a result, the alimentary limb was constructed in an anti-peristaltic way, and the whole gastric bypass was located far more distally than usual. Postoperatively, the patient presented with recurring nausea and vomiting. After several diagnostic steps, a computed tomography finally revealed the inadvertently reverse directed gastric bypass and the pre-existing condition of intestinal non-rotation. This was followed by a diagnostic laparoscopy and the reconstruction of the gastric bypass in "mirrored" technique.
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Affiliation(s)
- Ingeborg Bohlmann
- Department of General and Visceral Surgery, General Hospital of Bregenz, Carl-Pedenz-Straße 2, 6900, Bregenz, Austria.
| | - Werner Müller
- Department of General and Visceral Surgery, General Hospital of Bregenz, Carl-Pedenz-Straße 2, 6900, Bregenz, Austria
| | - Antonius Schuster
- Department of Radiology, General Hospital of Bregenz, Bregenz, Austria
| | - Claudius Falch
- Department of General and Visceral Surgery, General Hospital of Bregenz, Carl-Pedenz-Straße 2, 6900, Bregenz, Austria
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9
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Hassan LS, Fahmy MH, Elmonim AMA, Elshal M. Effect of post-gastric sleeve pyloric length on control of type II diabetes mellitus. THE EGYPTIAN JOURNAL OF SURGERY 2023; 42:464-472. [DOI: 10.4103/ejs.ejs_89_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background
Although the effectiveness and safety of laparoscopic sleeve gastrectomy (LSG) have been demonstrated, there is still debate about the best surgical method, with the resection distance from pylorus (DP) being among the most contentious topics. In patients who had LSG for morbid obesity, the effect of the resection distance from the pylorus on the management of type II diabetes mellitus during the postoperative phase was examined.
Patients and methods
After receiving each patient’s agreement, a total of 46 obese individuals were enrolled. Patients were prospectively randomized into two groups, group A (‘AP group’) and group B (‘AR group’), based on the distance between the initial reload firing and the pylorus (4 cm for group A and 2 cm for group B, respectively). Blood sugar levels were measured three, six months, and one year following LSG. After a year of follow-up, the percentage of excess weight loss (%EWL) was calculated.
Results
Postoperative weight was statistically significant lower and EWL% was statistically significant higher in group B: LSG ‘2 cm’ compared to group A: LSG ‘4 cm’. As regard outcomes of type 2 diabetes mellitus after LSG, in spite of nonsignificant statistical value, we reported that there was higher frequency of complete remission after 3, 6 and 12 months in group B: LSG ‘2 cm’ compared to group A: LSG ‘4 cm’ and cases with complete remission were associated with significant higher EWL%.
Conclusion
Patients undergoing laparoscopic sleeve gastrectomy are recommended to have shorter resection distance from pylorus (DP) done. It has been linked to superior surgical results, weight reduction, and diabetes mellitus management with no problems recorded.
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Affiliation(s)
| | - Mohamed H. Fahmy
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mohamed Elshal
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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10
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Yu X, Huang YH, Feng YZ, Cheng ZY, Wang CC, Cai XR. Association of body composition with postoperative complications after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Eur J Radiol 2023; 162:110768. [PMID: 36913816 DOI: 10.1016/j.ejrad.2023.110768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To evaluate predictive values of body composition parameters measured from preoperative CT/MRIs for postoperative complications after laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) in patients with obesity. METHODS In this retrospective case-control study, patients performing abdominal CT/MRIs within one month before and developing 30-day complications after bariatric procedures were matched for age, sex, and type of surgery with patients without complications (1/3 ratio, respectively). Complications were determined by documentation in the medical record. Two readers blindly segmented the total abdominal muscle area (TAMA) and visceral fat area (VFA) using predetermined thresholds for the Hounsfield unit (HU) on unenhanced CT and the signal intensity (SI) on T1-weighted MRI at the L3 vertebral level. Visceral obesity (VO) was defined as VFA > 136 cm2 in males and > 95 cm2 in females. These measures, along with perioperative variables, were compared. Multivariate logistic regression analyses were performed. RESULTS Of 145 included patients, 36 had postoperative complications. No significant differences between LSG and LRYGB were present regarding complications and VO. Hypertension (p = 0.022), impaired lung function (p = 0.018), American Society of Anesthesiologists (ASA) grade (p = 0.046), VO (p = 0.021), and VFA/TAMA ratio (p < 0.0001) were associated with postoperative complications in the univariate logistic analysis; the VFA/TAMA ratio was the only independent predictor in multivariate analyses (OR 2.01, 95% CI 1.37-2.93, p < 0.001). CONCLUSION The VFA/TAMA ratio provides important perioperative information in predicting patients who are likely to develop postoperative complications undergoing bariatric surgery.
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Affiliation(s)
- Xin Yu
- Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yan-Hao Huang
- Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - You-Zhen Feng
- Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Zhong-Yuan Cheng
- Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Cun-Chuan Wang
- Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Xiang-Ran Cai
- Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China.
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11
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Zulfiqar M, Ludwig DR, Strnad B, McVay M, Rengarajan A, Kushnir V, Mellnick V. Imaging features of marginal ulcers on multidetector CT. Clin Radiol 2023; 78:227-233. [PMID: 36376111 DOI: 10.1016/j.crad.2022.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/13/2022]
Abstract
AIM To assess the inter-reader agreement and frequency of various imaging findings of marginal ulcers on computed tomography (CT) in a series of patients with endoscopically or surgically confirmed marginal ulcer disease. MATERIALS AND METHODS This was a institutional review board-approved retrospective analysis involving a single academic institution. Eighty patients with a gastro-enteric anastomosis with confirmed marginal ulcer on endoscopy or surgery and multidetector (MD)CT performed within a month reviewed by two fellowship-trained abdominal radiologists to assess for the presence or absence of predetermined imaging characteristics categorised under signs of inflammation, signs of penetration, signs of perforation, and signs of obstruction. Inter-rater reliability was assessed using the Cohen kappa test. RESULTS Findings of perforation had moderate to substantial agreement, including the presence of extraluminal air, extraluminal fluid, and leakage of oral contrast medium (kappa 0.83 [0.61, 1.05], 0.57 [0.35, 0.79] and 0.75 [0.18, 1.31], respectively) although these were present relatively infrequently (23-26%, 30-43%, 3-4%, respectively). Additional imaging characteristics with moderate agreement were the presence of perienteric fat stranding, a dilated stomach proximal to the anastomosis, and penetration into adjacent organ (kappa 0.45 [0.23, 0.69], 0.47 [0.26, 0.69], and 0.47 [0.25, 0.69], respectively) which were variably present (80-88%, 11-16%, 5%, respectively). Wall thickening and contour abnormalities, although frequently present (61-90% and 60-80%, respectively) had only slight to fair agreement (kappa 0.09 [-0.14, 0.30] and 0.29 [0.07, 0.51]). CONCLUSION Signs of perforation have high inter-reader agreement but occur relatively infrequently. Fat stranding, wall thickening, and contour abnormalities are much more common; however, only fat stranding had moderate agreement.
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Affiliation(s)
- M Zulfiqar
- Department of Radiology, Mayo Clinic Phoenix Arizona, AZ, USA.
| | - D R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - B Strnad
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - M McVay
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - A Rengarajan
- Department of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
| | - V Kushnir
- Department of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
| | - V Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
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12
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de Araújo Martins-Romeo D, Rivera Domínguez A. Complications after abdominal surgery. RADIOLOGIA 2023; 65 Suppl 1:S99-S108. [PMID: 37024236 DOI: 10.1016/j.rxeng.2022.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/08/2022] [Indexed: 04/08/2023]
Abstract
Complications after abdominal surgery are often seen in emergency departments. Many postoperative complications (e.g., infections, abscesses, hematomas, and active bleeding) are common to all types of surgery; others are specific to different types of surgery. Computed tomography (CT) is the technique normally used to diagnose postoperative complications. This article reviews the changes that occur after some of the most common abdominal interventions that can be mistaken for pathological processes, the findings that can be considered normal after surgical intervention, and the most common early complications. It also describes the optimal protocols for CT studies depending on the different types of complications that are suspected.
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Affiliation(s)
| | - A Rivera Domínguez
- Servicio de Radiodiagnóstico, Hospital Universitario Virgen Macarena, Sevilla, Spain
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13
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Han L, Deng C, Zhao R, Wan Q, Zhang X, Wang X, Chen Y. Excess visceral fat area as an independent risk factor for early postoperative complications in patients with obesity undergoing bariatric surgery. Front Endocrinol (Lausanne) 2023; 14:1072540. [PMID: 36843597 PMCID: PMC9947141 DOI: 10.3389/fendo.2023.1072540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Few studies have investigated the correlation between visceral fat area (VFA) and early postoperative complications in patients with obesity undergoing bariatric surgery. This study aimed to investigate the relationship between VFA and early postoperative complications in patients with obesity following bariatric surgery. METHODS The study was conducted at a tertiary university hospital. Patients with obesity who underwent laparoscopic sleeve gastrectomy between June 2016 and October 2020 were divided into two groups based on umbilical level VFA: high-VFA group (umbilical level VFA ≥ 100 cm2) and low-VFA group (umbilical level VFA < 100 cm2). Baseline characteristics, intraoperative and postoperative conditions, and early postoperative complications were compared between the groups. The primary outcome was early postoperative complications, and the secondary outcome was postoperative hospital stay. RESULTS The study included 152 patients, with 82 patients in the low-VFA group and 70 patients in the high-VFA group. The high-VFA group had a higher incidence of early postoperative complications (14.29% vs. 2.44%, P = 0.013) than the low-VFA group. The length of postoperative hospital stay did not differ significantly between the groups. CONCLUSIONS Our study suggests that excess VFA is an independent risk factor for early postoperative complications following bariatric surgery, and VFA may be used in preoperative evaluations.
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Affiliation(s)
- Liping Han
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyi Deng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Zhao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qianyi Wan
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofang Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xiao Wang, ; Yi Chen,
| | - Yi Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xiao Wang, ; Yi Chen,
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14
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Chamaa B, Mouawad C, Dahboul H, El Feghali E, Kazan D, Sleilati F. Acute gastric twist after laparoscopic sleeve gastrectomy: A case series. Asian J Endosc Surg 2022. [PMID: 36517979 DOI: 10.1111/ases.13152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/27/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) has become the most performed bariatric procedure. Like any surgical intervention, LSG is not free from complications. One of the rarest complications is gastric sleeve stenosis, caused by either stricture or axial rotation of the stomach (twisted gastric tube). There is no consensus on the management of such a complication due to several underlying mechanisms and different timings of presentation. METHODS Between July 1, 2021 and December 31, 2021, we encountered three cases of acute gastric twist following LSG, and all of them required surgical intervention. All data (imaging results, operative reports and videos, discharge summaries, etc.) were retrospectively collected and analyzed after obtaining patients' informed consent. RESULTS We report three cases of acute gastric twist post-sleeve gastrectomy, diagnosed by different imaging modalities which showed localized distal gastric twist. All patients underwent exploratory laparoscopy which confirmed gastric sleeve twist. Gastropexy by fixation of the gastric tube to the transverse mesocolon was done in the first case which presented a localized partial distal twist, and a gastro-jejunal anastomosis proximal to the gastric twist was performed in the two other cases to bypass the obstruction. All of them had excellent postoperative results and a total symptomatic resolution. CONCLUSION We considered gastric tube fixation to the transverse mesocolon as a feasible option when the twist is local and partial. We also presented a new surgical modality to treat local complete distal gastric twist by a single gastro-jejunal latero-lateral anastomosis proximal to the twist, which seems safe and effective. The best method to treat such a complication is to prevent it by giving special attention to the different technical aspects of LSG.
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Affiliation(s)
- Bilal Chamaa
- Department of Digestive Surgery, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Christian Mouawad
- Department of Digestive Surgery, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Houssam Dahboul
- Department of Digestive Surgery, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Elie El Feghali
- Department of Digestive Surgery, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Daniel Kazan
- Department of Digestive Surgery, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Fadi Sleilati
- Department of General Surgery, Saint Joseph Hospital, Beirut, Lebanon
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15
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The incremental value of multislice CT in diagnosis of late bariatric surgery complications. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00856-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Bariatric surgery has become a widely accepted treatment option among the population for obesity management. Nevertheless, different complications may still be encountered during the late post-operative period. Our prospective cross-sectional study aimed to show the incremental value of multislice CT for diagnosis of such complications.
Results
Within the included twenty patients who underwent multislice CT of upper abdomen, gastric pouch dilatation causing recurrent weight gain was the commonest complication detected in 70% of the studied patients and was found mainly after sleeve gastrectomy in whom mean gastric pouch volume was 248.4 ml. Gastric stricture, gastric herniation through plication suture, hiatus hernia and incisional hernia were less commonly encountered complications.
Conclusion
Multislice CT is a useful non-invasive imaging modality for detection of late bariatric surgery complications.
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Iacobellis F, Dell’Aversano Orabona G, Brillantino A, Di Serafino M, Rengo A, Crivelli P, Romano L, Scaglione M. Common, Less Common, and Unexpected Complications after Bariatric Surgery: A Pictorial Essay. Diagnostics (Basel) 2022; 12:2637. [PMID: 36359480 PMCID: PMC9689585 DOI: 10.3390/diagnostics12112637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 06/27/2024] Open
Abstract
Bariatric surgery has demonstrated a higher rate of success than other nonsurgical treatments in selected patients with obesity; however, like all medical procedures, postoperative complications may occur, ranging between 2 and 10% and, although rare, they can be life threatening. Complications may be unspecific (any surgery-related complications) or specific (linked to the specific surgical procedure) and can be distinguished as common, less common, and unexpected. According to the onset, they may be acute, when occurring in the first 30 days after surgery, or chronic, with a presentation after 30 days from the procedure. The aim of this pictorial essay is to review the radiological aspects of surgical techniques usually performed and the possible complications, in order to make radiologists more confident with the postsurgical anatomy and with the normal and abnormal imaging findings.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | | | - Antonio Brillantino
- Department of Emergency Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | - Alessandro Rengo
- Department of Radiology, Pineta Grande Hospital, Via Domitiana KM 30, 81030 Castel Volturno, Italy
| | - Paola Crivelli
- Department of Surgery, Medicine and Pharmacy, University of Sassari, Via Roma 151, 07100 Sassari, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | - Mariano Scaglione
- Department of Surgery, Medicine and Pharmacy, University of Sassari, Via Roma 151, 07100 Sassari, Italy
- Department of Radiology, The James Cook University Hospital, Middlesbrough TS4 3BW, UK
- School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK
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17
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De Simone B, Chouillard E, Ramos AC, Donatelli G, Pintar T, Gupta R, Renzi F, Mahawar K, Madhok B, Maccatrozzo S, Abu-Zidan FM, E Moore E, Weber DG, Coccolini F, Di Saverio S, Kirkpatrick A, Shelat VG, Amico F, Pikoulis E, Ceresoli M, Galante JM, Wani I, De' Angelis N, Hecker A, Sganga G, Tan E, Balogh ZJ, Bala M, Coimbra R, Damaskos D, Ansaloni L, Sartelli M, Pararas N, Kluger Y, Chahine E, Agnoletti V, Fraga G, Biffl WL, Catena F. Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines. World J Emerg Surg 2022; 17:51. [PMID: 36167572 PMCID: PMC9516804 DOI: 10.1186/s13017-022-00452-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/16/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. METHOD A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. CONCLUSIONS The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting.
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Affiliation(s)
- Belinda De Simone
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy-Ile de France, France.
| | - Elie Chouillard
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy-Ile de France, France
| | - Almino C Ramos
- GastroObesoCenter Institute for Metabolic Optimization, Sao Paulo, Brazil
| | - Gianfranco Donatelli
- Interventional Endoscopy and Endoscopic Surgery, Hôpital Privé Des Peupliers, Paris, France
| | - Tadeja Pintar
- Department of Abdominal Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Rahul Gupta
- Division of Minimally Invasive Surgery and Bariatrics, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Federica Renzi
- General Surgery and Trauma Team, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162, Milano, Milan, Italy
| | - Kamal Mahawar
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Brijesh Madhok
- East Midlands Bariatric and Metabolic Institute, University Hospitals of Derby and Burton NHS Trust, Derby, UK
| | - Stefano Maccatrozzo
- Department of Bariatric Surgery, Istituto Di Cura Beato Matteo, Vigevano, Italy
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Ernest E Moore
- Denver Health System - Denver Health Medical Center, Denver, USA
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna Del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Andrew Kirkpatrick
- Department of General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Francesco Amico
- Department of Surgery, John Hunter Hospital and The University of Newcastle, Newcastle, MSW, Australia
| | - Emmanouil Pikoulis
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Joseph M Galante
- University of California, Davis 2315 Stockton Blvd., Sacramento, CA, 95817, USA
| | - Imtiaz Wani
- Government Gousia Hospital, Srinagar, Kashmir, India
| | - Nicola De' Angelis
- Service de Chirurgie Digestive Et Hépato-Bilio-Pancréatique - DMU CARE, Hôpital Henri Mondor, Paris, France
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Gabriele Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Edward Tan
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, CA, USA
| | - Dimitrios Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Luca Ansaloni
- Department of Surgery, Pavia University Hospital, Pavia, Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, Macerata, Italy
| | - Nikolaos Pararas
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Elias Chahine
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy-Ile de France, France
| | - Vanni Agnoletti
- Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Gustavo Fraga
- School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Walter L Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA, USA
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
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Shetye B, Hamilton FR, Bays HE. Bariatric surgery, gastrointestinal hormones, and the microbiome: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 2:100015. [PMID: 37990718 PMCID: PMC10661999 DOI: 10.1016/j.obpill.2022.100015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of bariatric surgery (i.e., bariatric procedures that improve metabolic disease are often termed "metabolic and bariatric surgery"), gastrointestinal hormones, and the microbiome as they relate to patients with obesity. Methods The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results This CPS includes the pros and cons of the most common types of bariatric procedures; the roles of gastrointestinal (GI) hormones in regulating hunger, digestion, and postabsorptive nutrient metabolism; and the microbiome's function and relationship with body weight. This CPS also describes patient screening for bariatric surgery, patient care after bariatric surgery, and treatment of potential nutrient deficiencies before and after bariatric surgery. Finally, this CPS explores the interactions between bariatric surgery, GI hormones, and the microbiome. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) regarding bariatric surgery, gastrointestinal hormones, and the microbiome is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Implementation of appropriate care before and after bariatric surgery, as well as an awareness of GI hormones and the microbiome, may improve the health of patients with obesity, especially patients with adverse fat mass and adiposopathic metabolic consequences.
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Affiliation(s)
- Bharti Shetye
- Diplomate American Board of Obesity Medicine, Medical Director, Dr. Abby's Weight Management Clinic, 6101 Webb Road, Suite 207, Tampa, FL, 33615, USA
| | - Franchell Richard Hamilton
- Diplomate American Board of Obesity Medicine, A Better Weigh Center, 8865 Davis Blvd Ste 100, Keller, TX, 76248, USA
| | - Harold Edward Bays
- Diplomate American Board of Obesity Medicine, Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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19
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Burt JR, Kocher MR, Snider L, Waltz J, Chamberlin JH, Aquino GJ, Giovagnoli V, Mercer M, Feranec N. Computed Tomography Assessment of Gastric Band Slippage. Visc Med 2022; 38:288-294. [PMID: 36160820 PMCID: PMC9421695 DOI: 10.1159/000524588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 04/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background The purpose of this study was to develop and validate reliable computed tomography (CT) imaging criteria for the diagnosis of gastric band slippage. Material and Methods We retrospectively evaluated 67 patients for gastric band slippage using CT. Of these, 14 had surgically proven gastric band slippage (study group), 22 had their gastric bands removed for reasons other than slippage (control group 1), and 31 did not require removal (control group 2). All of the studies were read independently by two radiologists in a blinded fashion. The “O” sign, phi angle, amount of inferior displacement from the esophageal hiatus, and gastric pouch size were used to create CT diagnostic criteria. Standard statistical methods were used. Results There was good overall interobserver agreement for diagnosis of gastric band slippage using CT diagnostic criteria (kappa = 0.83). Agreement was excellent for the “O” sign (kappa = 0.93) and phi angle (intraclass correlation coefficient = 0.976). The “O” sign, inferior displacement from the hiatus >3.5 cm, and gastric pouch volume >55 cm3 each had 100% positive predictive value. A phi angle <20° or >60° had the highest negative predictive value (NPV) (98%). Of all CT diagnostic criteria, enlarged gastric pouch size was most correlated with band slippage with an AUC of 0.991. Conclusion All four imaging parameters were useful in evaluating for gastric band slippage on CT, with good interobserver agreement. Of these parameters, enlarged gastric pouch size was most correlated with slippage and abnormal phi angle had the highest NPV.
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Affiliation(s)
- Jeremy R. Burt
- Department of Radiology and Radiological Sciences, Cardiothoracic Division, Medical University of South Carolina, Charleston, South Carolina, USA
- *Jeremy R. Burt,
| | - Madison R. Kocher
- Department of Radiology and Radiological Sciences, Cardiothoracic Division, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lauren Snider
- Department of Radiology and Radiological Sciences, Cardiothoracic Division, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jeffrey Waltz
- Department of Radiology and Radiological Sciences, Cardiothoracic Division, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jordan Heston Chamberlin
- Department of Radiology and Radiological Sciences, Cardiothoracic Division, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gilberto J. Aquino
- Department of Radiology and Radiological Sciences, Cardiothoracic Division, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vincent Giovagnoli
- Department of Radiology and Radiological Sciences, Cardiothoracic Division, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Megan Mercer
- Department of Radiology and Radiological Sciences, Cardiothoracic Division, Medical University of South Carolina, Charleston, South Carolina, USA
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Small bowel obstruction following laparoscopic Roux-en-Y gastric bypass: is it always necessary to operate? A 5-year, high volume center experience. Langenbecks Arch Surg 2021; 406:1839-1846. [PMID: 34259917 DOI: 10.1007/s00423-021-02262-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aims to describe the incidence, associated factors, etiology, and management of small bowel obstructions following laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS A retrospective analysis was conducted between January 15 and December 19 using the surgery database of our hospital. Included LRYGB patients were those that evolved with a prolonged length of stay; readmission; emergency room consult; and re-intervention due to small bowel obstruction (SBO) related symptoms with compatible radiological or intraoperative findings. The LRYGB technique implied an antecolic alimentary limb reconstruction and systematic closure of mesenteric defects. Descriptive and analytical statistics were carried out, using a parametric or non-parametric approach as needed. RESULTS Nine hundred forty-one LRYGB were performed. 9.9% were revisional surgeries of patients with a laparoscopic sleeve gastrectomy. During the study period, 36 SBOs occurred, representing 3.8% of operated patients, with no mortality. 58.3% had successful non-operative management, while 41.7% required surgical exploration, of which 73.3% were treated laparoscopically and 20% needed conversion to open surgery. Etiologies of SBO were jejuno-jejunostomy (JJO) related stenosis (22, 61.1%), internal hernias (6, 16.7%), adherences (3, 8.3%), and other diagnoses (5, 13.9%). Regarding JJO stenosis and internal hernias, median time to diagnosis was 8 days (IQR 7-11) and 12 months (IQR 8.7-16) respectively. Previous sleeve gastrectomy, age, or sex was not associated to the incidence of small bowel obstruction. CONCLUSIONS LRYGB is safe when performed by experienced surgeons. SBO due to internal hernias were scarce in this series. JJO stenosis could explain most cases of SBO; under this diagnosis, non-surgical management was successful frequently.
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21
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Optimizing detection of postoperative leaks on upper gastrointestinal fluoroscopy: a step-by-step guide. Abdom Radiol (NY) 2021; 46:3019-3032. [PMID: 33635362 DOI: 10.1007/s00261-021-02978-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/22/2021] [Accepted: 02/09/2021] [Indexed: 11/27/2022]
Abstract
Postoperative leaks after gastrointestinal surgery are important to identify to decrease patient morbidity and mortality. Fluoroscopic studies are commonly employed to detect postoperative leak. While the literature addresses the sensitivity and specificity of these examinations, there is generally a lack of description of the fluoroscopic technique itself and there may be variability between radiologists in how these studies are performed. It is important to balance a standardized fluoroscopy protocol while tailoring the exam for each surgical and patient situation. Here we will briefly review common postoperative anatomy in the upper gastrointestinal tract, propose fluoroscopic techniques to improve postoperative leak detection, and illustrate teaching points with clinical cases.
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22
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Quantification of gastric sleeve stenosis using endoscopic parameters and image analysis. Gastrointest Endosc 2021; 93:1344-1348. [PMID: 33316244 DOI: 10.1016/j.gie.2020.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/03/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Sleeve gastrectomy has quickly become the most commonly performed bariatric surgery. In light of its increasing popularity, the prevalence of gastric sleeve stenosis (GSS) continues to rise. Management with serial pneumatic dilation is highly successful but underused because of a lack of quantitative diagnostic criteria. We aimed to develop quantifiable endoscopic criteria to characterize GSS based on the (1) ratio of narrowest to widest gastric lumen diameter, (2) endoscope angulation/trajectory required for passage, and (3) presence of bilious fluid pooling in the proximal sleeve and compare it with endoluminal functional lumen imaging probe (EndoFLIP) diameter and distensibility indices (DIs) and endoscopic documentation of gastric lumen morphology. METHODS We retrospectively reviewed a prospectively maintained database of patients undergoing endoscopy to assess for GSS. Endoscopic images were reviewed in a blinded fashion by 2 bariatric endoscopists. The narrowest and widest part of the gastric lumen diameters were noted on each image, in addition to a hypothetical trajectory required for endoscope passage. Using image processing software, we calculated the the ratio of diameters (ie, narrowest divided by widest) and angle of endoscope trajectory. The presence of bilious fluid pooling in the proximal gastric lumen was noted. These values were then compared with EndoFLIP parameters and endoscopic documentation of gastric lumen morphology. RESULTS Thirty patients met inclusion criteria, and 26 (87%) were found to have a stenosis on endoscopy. Of those, 9 (35%) were characterized as mild, 11 (42%) as moderate, and 6 (23%) as severe. There was no difference in demographic information between patients with and without stenosis. In patients with stenosis, mean EndoFLIP diameters and DIs were 12.9 ± 3.9 mm and 11.0 ± 6.8 mm2/mm Hg, respectively. In patients without stenosis, mean EndoFLIP diameters and DIs were 19.9 ± 2.9 mm and 21.5 ± 1.0 mm2/mm Hg, respectively. Patients with stenosis had significantly lower diameter ratios compared with those without stenosis (.27 ± .14 vs .48 ± .77, P = .01). Diameter ratios were also inversely related to severity of sleeve stenosis (β = -.08, P = .01). Patients with stenosis were also more likely to have fluid pooling (96.2% vs 25%, P < .001). There was no significant difference in the trajectory of endoscope passage between the 2 groups. CONCLUSIONS Endoscopic criteria for diagnosis of GSS are lacking. Our data suggest the ratio between the narrowest and widest gastric lumen diameters and presence of pooled fluid is associated with diagnosis of stenosis by EndoFLIP and gastric lumen morphology. Future studies to validate these criteria are needed.
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Imaging after laparoscopic sleeve gastrectomy - literature review with practical recommendations. Pol J Radiol 2021; 86:e325-e334. [PMID: 34136051 PMCID: PMC8186309 DOI: 10.5114/pjr.2021.106795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/06/2020] [Indexed: 11/17/2022] Open
Abstract
In the XXI century obesity has become one of the most demanding epidemiological threats worldwide. At the same time, bariatric surgery has established itself as an effective treatment for morbidly obese patients, with laparoscopic sleeve gastrectomy (LSG) emerging as the most popular bariatric procedure. This paper reviews the role of imaging studies of patients after LSG. Computed tomography is widely considered as the method of choice in detection of complications in early postoperative period. The dynamic character of upper gastrointestinal examination allows for the assessment of passage through the gastric remnant. The paper also discusses evaluation of the shape and volume of the gastric remnant assessed by imaging studies.
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Girishekar B, Rawat S, Ananthasivan R, Reddy P, Patil P, Kaushik K. Role of Imaging in Bariatric Surgery: A Review of the Various Surgical Techniques and Their Complications. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1725240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractAccording to the World Health Organization, obesity has reached epidemic proportions globally, with at least 2.8 million people dying each year as a result of being overweight or obese. Bariatric surgery is being increasingly used as a form of treatment, particularly in those patients where lifestyle modifications are deemed insufficient. With the role of radiologists transitioning from a medical to a surgical evaluation in obesity, it is becoming increasingly important to familiarize oneself with the various imaging techniques used in the preoperative and postsurgical evaluation in such cases. This article aims to review the various surgeries performed, their normal imaging appearance, and the various complications that could be encountered.
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Affiliation(s)
| | - Sudarshan Rawat
- Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
| | - Rupa Ananthasivan
- Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
| | - Pramesh Reddy
- Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
| | - Pooja Patil
- Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
| | - Kavya Kaushik
- Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
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Diagnostic imaging in the diagnosis of acute complications of bariatric surgery. Pol J Radiol 2021; 86:e102-e111. [PMID: 33758635 PMCID: PMC7976234 DOI: 10.5114/pjr.2021.104003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/21/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose The aim of study is to identify the frequency of acute complications and imaging findings at gastro-intestinal transit (GI) and computerised tomography (CT) in a group of obese patients who developed clinical suspicion of acute complications (painful and meteoric abdomen, nausea, vomiting, fever, intestinal blockage) in post bariatric surgery. Material and methods We retrospectively review 954 obese patients who underwent bariatric surgery between 2013 and 2019. The study included 72 patients who developed clinical suspicion of acute complications (painful and meteoric abdomen, nausea, vomiting, fever, intestinal blockage) within 6 days of bariatric surgery of sleeve gastrectomy, gastric banding, gastric bypass with Roux loop confirmed by CT, and who underwent a gastrointestinal transit before the CT examination. Results GI exam allowed visualisation of 58% of complications. Analysing the data for each surgical technique, 46 post-operative complications were found involve gastric banding. The most frequent was bandage migration (26 cases, 56 %), identified in all cases at GI transit and then confirmed on CT. Conclusions The study suggests that CT should be used to clarify all doubtful or clinically discordant GI transit exam results. The participation of a radiologist in qualification and post-operative evaluation is important for bariatric surgery patients.
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Latif MA, Fouda N, Omran E, Refaey MS. Role of imaging in assessment and detection of complications after bariatric surgery. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00157-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Abstract
Background
Bariatric surgery is performed to control morbid obesity secondary to failed medical approaches. Practical knowledge of post-surgical anatomy allows accurate interpretation of imaging findings related to normal post-surgical anatomy and common post-surgical complications.
The purpose of this study was to highlight the role of imaging in the assessment and detection of complications after bariatric surgery.
Results
This prospective study included 49 patients who had bariatric surgery. Sleeve gastrectomy was the most common bariatric surgery. The leak was the commonest complication (12%). The sensitivity of upper GI series for diagnosis of post-operative complication after bariatric surgery was 70% and specificity 94% while the sensitivity of CT study was 95% and specificity 95%.
Conclusion
CT has a golden role in the diagnosis of post-operative complications. Both post-contrast CT and upper GI series should be used in diagnosing complications following bariatric surgery. US is useful for diagnosis of a superficial problem.
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The role of the surgical resection distance from the pylorus after laparoscopic sleeve gastrectomy: a prospective cohort study from an academic medical center in Egypt. Patient Saf Surg 2020; 14:42. [PMID: 33292433 PMCID: PMC7672815 DOI: 10.1186/s13037-020-00270-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/09/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy was recently described as an effective approach for the operative treatment of obesity, but the ideal procedure remains controversial. One of the most debated issues is the resection distance from the pylorus. We conducted this study to elucidate any potential differences in the short-term outcomes between 2 and 6 cm distance from the pylorus in laparoscopic sleeve gastrectomy. METHODS A prospective observational cohort study in a selected cohort of 96 patients was conducted from January 2018 to March 2019 in morbidly obese patients who had laparoscopic sleeve gastrectomy performed at Suez Canal University Hospital. Outcome was expressed by excess weight loss percentage, resolution of comorbidities, improvement of quality of life, and incidence of complications after laparoscopic sleeve gastrectomy. The morbidly obese patients (body mass index [BMI] > 40 kg/m2 or > 35 kg/m2 with obesity-related comorbidities) in the study were divided into two equal groups: (1) Group 1 (48 patients) underwent laparoscopic sleeve gastrectomy with a 2 cm distance from the pylorus resection distance and (2) Group 2 (48 patients) underwent laparoscopic sleeve gastrectomy with a 6 cm distance from the pylorus resection distance. Body weight, BMI, bariatric quality of life, lipid profile, and comorbidities were evaluated pre- and post-operatively for a duration of 12 months. RESULTS Statistically, no significant differences between the two study groups regarding the excess weight loss percentage, comorbidity resolution throughout the postoperative follow-up, enhancement of the quality of life score throughout the postoperative follow-up, or incidence of complications (25% in Group 1 versus 25% in Group 2, p > 0.05) were found. CONCLUSION Laparoscopic sleeve gastrectomy was an effective and safe management for morbid obesity and obesity-related comorbidities with significant short-term weight loss; it also improved weight-related quality of life and had an acceptable complication rate. The distance from the pylorus resection distance did not affect the short-term effects of laparoscopic sleeve gastrectomy regarding excess weight loss percentage, resolution of comorbidities, change in quality of life, or occurrence of complications.
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Raspante LBDP, Barquette ÁDC, Motta EGPC, Ribeiro MA, Ramos LFM, Moreira W. Review and pictorial essay on complications of bariatric surgery. ACTA ACUST UNITED AC 2020; 66:1289-1295. [PMID: 33027460 DOI: 10.1590/1806-9282.66.9.1289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/22/2020] [Indexed: 11/21/2022]
Abstract
Obesity is a chronic disease characterized by excess fat in the body and a real public health problem. Bariatric surgery, in recent decades, has gained space in its treatment due to the efficiency obtained in weight loss and significant reduction of the related comorbidities. The most commonly performed bariatric procedures include Roux-en-Y gastric bypass, adjustable gastric band, and laparoscopic sleeve gastrectomy. Possible complications described include fistulas, dehiscence, marginal ulcers, intestinal obstruction, internal hernias, and anastomotic stenosis. These complications may have unfavorable clinical outcomes since symptoms are often nonspecific. Abdominal computed tomography (CT) is an important tool in the evaluation of postoperative complications, both in the immediate and late postoperative status of patients undergoing such a procedure. We analyzed the most illustrative tomographic findings of the different complications after reducing gastroplasty in 203 patients without distinction of age or gender. Correct interpretation requires radiologists to understand the surgical technique since postoperative anatomy and surgery-specific complications may be obstacles to proper interpretation.
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Affiliation(s)
- Laio Bastos de Paiva Raspante
- Médico com Pós-Graduação em Radiologia e Diagnóstico por Imagem - Ciências Médicas de Minas Gerais (PGCM-MG) - Fundação Educacional Lucas Machado (Feluma), Belo Horizonte, MG, Brasil
| | - Ávanny do Carmo Barquette
- Médico com Pós-Graduação em Radiologia e Diagnóstico por Imagem - Ciências Médicas de Minas Gerais (PGCM-MG) - Fundação Educacional Lucas Machado (Feluma), Belo Horizonte, MG, Brasil
| | | | | | | | - Wanderval Moreira
- Médico Radiologista da Rede MaterDei de Saúde - Radiologia, Belo Horizonte, MG, Brasil
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Chatterjee A, Ramanan RV, Mukhopadhyay S. Imaging Postoperative Abdominal Hernias: A Review with a Clinical Perspective. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0040-1715772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractPostoperative internal hernia is a challenging but critical diagnosis in postoperative patients presenting with acute abdomen. Postoperative internal hernias are increasingly being recognized after Roux-en-Y gastric bypass (RYGB) and bariatric surgeries. These internal hernias have a high risk of closed-loop obstruction and bowel ischemia; therefore, prompt recognition is necessary. Computed tomography (CT) is the imaging modality of choice in cases of postoperative acute abdomen. Understanding the types of postoperative internal hernia and their common imaging features on CT is crucial for the abdominal radiologist. Postoperative external hernias are usually a result of defect or weakness of the abdominal wall created because of the surgery. CT helps in the detection, delineation, diagnosis of complications, and surgical planning of an external hernia. In this article, the anatomy, pathophysiology, and CT features of common postoperative hernias are discussed. Afterreading this review, the readers should be able to (1) enumerate the common postoperative internal and external abdominal hernias, (2) explain the pathophysiology and surgical anatomy of Roux-en-Y gastric bypass-related hernia, (3) identify the common imaging features of postoperative hernia, and (4) diagnose the complications of postoperative hernias.
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Affiliation(s)
- Argha Chatterjee
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | | | - Sumit Mukhopadhyay
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
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Bordonaro V, Brizi MG, Lanza F, Gallucci P, Infante A, Giustacchini P, Sessa L, Ciccoritti L, Danza FM, Manfredi R, Raffaelli M. Role of CT imaging in discriminating internal hernia from aspecific abdominal pain following Roux-en-Y gastric bypass: a single high-volume centre experience. Updates Surg 2020; 72:1115-1124. [PMID: 32306275 DOI: 10.1007/s13304-020-00767-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 04/11/2020] [Indexed: 04/23/2023]
Abstract
Internal hernia (IH) represents a delayed complication of the laparoscopic Roux-en-Y gastric bypass (LRYGB) and it is historically difficult to identify preoperatively. Numerous CT signs were considered suggestive of IH but none of them is pathognomonic. In this study, we aim to evaluate the accuracy of CT in diagnosing IH, differentiating from non-specific abdominal pain. This can lead to a way of personalized medicine and improve the outcome of anti-obesity treatments. We retrospectively reviewed CT scans of 50 patients previously subjected to LRYGB procedure, with a clinical suspicion of IH. 3 groups of patients were identified: IH group (21 patients with a surgical confirmed IH), negative group (12 patients in whom IH was not confirmed at surgery), and control group (17 patients who were not surgically explored because of low/no suspicion of IH). We divided CT signs into three groups: "bowel loop signs", "vessel signs", and "venous congestion/stasis signs". The accuracy of CT in detecting IH was tested by comparing each sign, either individually or in combination, with the surgical findings. Statistical analysis showed that "vessel signs" (swirl sign, superior mesenteric vein beaking, mesenteric arteries, and veins branches inversion) present the highest distribution in patients with IH demonstrated at surgery, with a higher accuracy in case of simultaneous presence of two or three signs. CT imaging is highly accurate in diagnosing IH. Despite no single sign being pathognomonic, the combination of two or more signs, especially among the "vessels signs", can suggest the IH, even in pauci-symptomatic patients.
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Affiliation(s)
- Veronica Bordonaro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS-Università Cattolica Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy. .,Istituto di Radiologia, Università Cattolica Sacro Cuore, Rome, Italy.
| | - Maria Gabriella Brizi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS-Università Cattolica Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.,Istituto di Radiologia, Università Cattolica Sacro Cuore, Rome, Italy
| | - Francesca Lanza
- Unità di Radiodiagnostica, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Pierpaolo Gallucci
- Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-urologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Amato Infante
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS-Università Cattolica Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Piero Giustacchini
- Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-urologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Chirurgia Endocrina e Metabolica, Department of Endocrine and Metabolic Surgery, Mater Olbia Hospital, Olbia, Italy
| | - Luca Sessa
- Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-urologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Luigi Ciccoritti
- Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-urologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Francesco Maria Danza
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS-Università Cattolica Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.,Istituto di Radiologia, Università Cattolica Sacro Cuore, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS-Università Cattolica Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.,Istituto di Radiologia, Università Cattolica Sacro Cuore, Rome, Italy
| | - Marco Raffaelli
- Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-urologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Istituto di Semeiotica Chirurgica, Università Cattolica Sacro Cuore, Rome, Italy
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Bassiouny RH, Chalabi NAM. Value of contrast-enhanced multidetector computed tomography in imaging of symptomatic patients after laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-019-0090-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Abstract
Background
To assess the role of contrast-enhanced multidetector computed tomography (MDCT) in the assessment of symptomatic patients following laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy.
Results
We reviewed the studies of 129 cases and found complications in 113 patients: 55 early complications and 48 late complications. All of these complications were diagnosed with intravenous contrast-enhanced MDCT. Statistically significant difference was found between UGIS and MDCT in the diagnosis of many cases.
Conclusion
The rate of complications in bariatric surgery is high and the associated mortality is not negligible. The interpreting radiologists should know the normal postoperative findings and be aware of possible complications.
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De Simone B, Ansaloni L, Sartelli M, Kluger Y, Abu-Zidan FM, Biffl WL, Heyer A, Coccolini F, Baiocchi GL, Catena F. The Operative management in Bariatric Acute abdomen (OBA) Survey: long-term complications of bariatric surgery and the emergency surgeon's point of view. World J Emerg Surg 2020; 15:2. [PMID: 32005129 PMCID: PMC6945511 DOI: 10.1186/s13017-019-0281-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/16/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The number of bariatric procedures is increasing worldwide. No consensus or guidelines about the emergency management of long-term complications following bariatric surgery are currently available. The aim of this study is to investigate by a web survey how an emergency surgeon approaches this unique group of patients in an emergency medical scenario and to report their personal experience. METHOD An international web survey was sent to 197 emergency surgeons with the aim to collect data about emergency surgeons' experience in the management of patients admitted in the emergency department for acute abdominal pain after bariatric surgery. The survey was conceived as a questionnaire composed by 26 (multiple choice and open) questions and approved by a steering committee. RESULTS One hundred seventeen international emergency surgeons decided to join the project and answered to the web survey with a response rate of 59.39%. CONCLUSIONS The aim of this WSES web survey was to highlight the current management of patients previously submitted to bariatric surgical procedures by ES. Emergency surgeons must be mindful of postoperative bariatric surgery complications. CT scan with oral intestinal opacification may be useful in making a diagnosis if carefully interpreted by the radiologist and the surgeon. In case of inconclusive clinical and radiological findings, when symptoms fail to improve, surgical exploration for bariatric patients presenting acute abdominal pain, by laparoscopy if expertise is available, is mandatory in the first 12-24 h, to have good outcomes and decrease morbidity rate.
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Affiliation(s)
- Belinda De Simone
- Department of General and Emergency Surgery, Azienda Usl Reggio Emilia IRCCS, Reggio Emilia, Italy
| | - Luca Ansaloni
- Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata’s Hospital, Macerata, Italy
| | - Yoram Kluger
- Department of Emergency and Trauma Surgery, Rambam Health Campus, Haifa, Israel
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Walter L. Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, California USA
| | - Arianna Heyer
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA
| | | | | | - Fausto Catena
- Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy
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Abstract
We present a case-based review of abdominal postoperative complications, organized by organ system affected, including wound/superficial, hepatobiliary, pancreatic, gastrointestinal, genitourinary, and vascular complications. Both general complications and specific considerations for certain types of operations are described, as well as potential pitfalls that can be confused with complications. Representative cases are shown using all relevant imaging modalities, including CT, fluoroscopy, ultrasound, MRI, and nuclear medicine. Management options are also described, highlighting those that require radiologist input or intervention.
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Affiliation(s)
- Ryan B O'Malley
- Department of Radiology, Abdominal Imaging, University of Washington, 1959 Northeast Pacific Street, Box 357115, Seattle, WA 98195, USA.
| | - Jonathan W Revels
- Department of Radiology, Body and Thoracic Imaging, University of New Mexico, Albuquerque, NM, USA
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34
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Page M, Drummond J, Magdy M, Vedelago J, Kuzinkovas V. Imaging appearance on CT post laparoscopic Roux-en-Y gastric bypass using bioabsorbable prosthesis with fibrin glue fixation to prevent a Petersen's space hernia. BJR Case Rep 2019; 5:20180111. [PMID: 31555470 PMCID: PMC6750627 DOI: 10.1259/bjrcr.20180111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 11/21/2022] Open
Abstract
Imaging post bariatric surgery is becoming more common over the past decade due to increasing incidence of obesity in the population and subsequent treatment. In recent years, the use of topical haemostatic agents and bioabsorbable prostheses has increased leading to higher likelihood of encountering these agents on post-operative imaging. Imaging in the post-operative period is occasionally performed to assess for complications such as obstruction, leak and abscess formation. Familiarity with these agents is crucial in preventing incorrect diagnosis. Laparoscopic Roux-en-Y gastric bypass (RYGB) is favoured over the open approach as it is safer and more effective, with a mortality rate of 0.5% and morbidity around 7–14 %. The main cause of late post-RYGB complications is the development of internal hernias such as a Petersen’s hernia. During the procedure, a space between the alimentary loop of the small bowel and the transverse mesocolon is created and is called the Petersen’s defect. Subsequently, a part of the small bowel can herniate through this orifice. As this operation is becoming more common, the incidence of internal herniation has been increasing. This case report describes a new bariatric surgical technique and the associated post-operative radiological appearances on CT. The surgical technique has been pioneered in Sydney, Australia and involves a laparoscopic RYGB using bioabsorbable prosthesis with fibrin glue fixation to prevent a Petersen’s space hernia.
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Affiliation(s)
- Mark Page
- Department of Radiology, Tel Aviv Sourasky Medical Center, Israel
| | | | - Mark Magdy
- Department of Surgery, St George Private Hospital, Sydney, Australia
| | - John Vedelago
- Department of Radiology, St Mary's Hospital, London, UK
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Abu Arab WS, Alqannas MH. Thoracic complications in bariatric surgery patients. Asian Cardiovasc Thorac Ann 2019; 27:573-583. [PMID: 31412709 DOI: 10.1177/0218492319870926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Obesity is a health issue that can lead to medical and psychological problems. Recently, bariatric surgery has become the best choice for treatment of selected candidates. As the number of bariatric surgeries increases, various related postoperative complications are being encountered. Most studies have been concerned with abdominal complications and thoracic complications were beyond their scope. The aim of this report was to review thoracic complications following bariatric surgery, in terms of incidence, management, and outcome. A literature search of English language published data concerning thoracic complications related to or following bariatric surgery was performed in November 2018. A total of 10,145 results were found. After screening titles and abstracts, 10,060 noneligible publications were excluded. Eighty-five publications were potentially eligible and their full texts were analyzed. After excluding overlapping series of patients, 44 studies were selected. These included 934 patients. Females accounted for 87.9% of the included patients. Ages ranged between 21 and 64 years (mean 43.86 ± 4.4 years). Most frequently encountered complications were esophageal (80.84%) followed by pulmonary (17.45%). The majority of esophageal complications were functional (82.38%) in contrast to the pulmonary type that were mostly organic (87.73%). There were 5 documented deaths. We concluded that thoracic complications are not infrequent after bariatric surgery. Esophageal and pulmonary are the most common thoracic complications reported. The outcome is usually favorable. Mortality may be avoided when complications are detected early and well-managed.
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Affiliation(s)
- Walid S Abu Arab
- 1 Thoracic Surgery Department, King Khalid Hospital, Najran, Saudi Arabia.,2 Cardiothoracic Surgery Department, University of Alexandria, Egypt
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Delaney FT, Franz R. Abdominal viscus penetration by laparoscopic-adjustable gastric band tubing: case report and review. BJR Case Rep 2019; 4:20170097. [PMID: 30931132 PMCID: PMC6438395 DOI: 10.1259/bjrcr.20170097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 05/05/2018] [Accepted: 05/10/2018] [Indexed: 11/05/2022] Open
Abstract
Laparoscopic-adjustable gastric band (LAGB) complications are increasingly recognised as follow-up time increases. These are most commonly related to the gastric band or port site, but complications of the connecting tubing are also reported. We present a case of LAGB tubing penetration through the transverse colon causing abdominal sepsis in a complex surgical abdomen and review prior published cases of abdominal viscus penetration by LAGB tubing. Like complications involving all LAGB components, these often present with non-specific abdominal signs and symptoms and undergo abdominal CT as an early investigation. This makes knowledge of normal and pathological imaging features of LAGB components important in radiology practice.
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Affiliation(s)
- Francis T Delaney
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Robert Franz
- Department of General Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia
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Suri K, Tran K, Whang G. Gastric remnant perforation in a gastric bypass patient secondary to splenic artery pseudoaneurysm: radiologic-surgical correlation. Clin Imaging 2019; 54:159-162. [DOI: 10.1016/j.clinimag.2019.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/01/2018] [Accepted: 01/07/2019] [Indexed: 11/15/2022]
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The role of MDCT study to assess postoperative acute complications of laparoscopic sleeve gastrectomy (LSG). THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Payá-Llorente C, Martínez-Pérez A, Gómez-Abril SA, Armañanzas-Villena E. Laparoscopic management of gastric perforation secondary to mesenteroaxial volvulus in a patient with laparoscopic adjustable gastric banding. Asian J Endosc Surg 2018; 11:417-419. [PMID: 29512332 DOI: 10.1111/ases.12473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/30/2022]
Abstract
A 54-year-old woman was admitted to the emergency department with a 2-week history of alimentary vomiting. She had undergone laparoscopic adjustable gastric banding 6 years earlier. CT revealed a mesenteroaxial gastric volvulus and ischemia on the gastric wall. Emergent diagnostic laparoscopy was performed, and severe peritonitis and gastric necrosis caused by volvulation was found. After band removal, a fundal perforation was noted, but a viable lesser curvature enabled laparoscopic sleeve gastrectomy to be performed. The postoperative course was uneventful. Laparoscopic adjustable gastric banding is considered a safe and effective method for the surgical treatment of obesity, but it is associated with a number of complications, such as pouch dilatation and band slippage. Although infrequent, ischemic complications are life-threatening conditions that require urgent surgery. This is the first report of this unusual complication managed laparoscopically.
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Kerpel A, Klang E, Konen E, Marom EM, Amitai MM. Gastric Banding: Complications Identified by CT. Obes Surg 2018; 29:499-505. [PMID: 30280333 DOI: 10.1007/s11695-018-3534-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Laparoscopic adjustable gastric banding (LAGB) used to be a common procedure at the turn of the century and is still frequently encountered on CT scans in common clinical practice. Our aim is to present the frequency and spectrum of complication associated with LAGB, as observed in CT. MATERIALS AND METHODS After approval of our institutional review board, a retrospective search for LAGB in CT interpretations using the term "band" between December 2011 and April 2017 was conducted. CT scans were reviewed to identify complications. The findings were divided into two groups: symptomatic, in which the complications caused acute symptoms for which CT scans were conducted, and incidental, in which complications were incidentally identified. The frequency of complications was calculated. RESULTS We identified 160 patients who underwent LAGB and performed a CT scan. Complications were identified in 69/160 (43.1%) patients, with a total of 83 findings: 47/160 (29.4%) esophageal dilatation, 13/160 (8.2%) pulmonary complications, 6/160 (3.8%) abdominal abscesses, 5/160 (3.1%) small bowel obstructions, 4/160 (2.5%) intragastric band erosions, 4/160 (2.5%) tube disconnections, 3/160 (1.9%) port site and tube course infections, and 1/160 (0.6%) small pouch bezoars. When compared with patients' referral notes, 38/83 (45.8%) of the findings were associated with acute symptoms, whereas 45/83 (54.2%) of the findings were incidental. Eighteen percent of the incidental complications were clinically important. CONCLUSION Complications were found in 43% of CT scans of patients who underwent LAGB; less than half of the findings were symptomatic. Some of the incidentally identified complications had substantial clinical importance.
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Affiliation(s)
- Ariel Kerpel
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, 52621, Ramat Gan, Israel.
| | - Eyal Klang
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, 52621, Ramat Gan, Israel
| | - Eli Konen
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, 52621, Ramat Gan, Israel
| | - Edith Michelle Marom
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, 52621, Ramat Gan, Israel
| | - Marianne Michal Amitai
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, 52621, Ramat Gan, Israel
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Kalff MC, de Raaff CA, de Vries CE, Coblijn UK, Willink MT, Fauquenot-Nollen JM, Jensch S, de Castro SM, van Veen RN. Diagnostic value of computed tomography for detecting anastomotic or staple line leakage after bariatric surgery. Surg Obes Relat Dis 2018; 14:1310-1316. [DOI: 10.1016/j.soard.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/03/2018] [Accepted: 05/11/2018] [Indexed: 11/29/2022]
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Levy JL, Levine MS, Rubesin SE, Williams NN, Dumon KR. Stenosis of gastric sleeve after laparoscopic sleeve gastrectomy: clinical, radiographic and endoscopic findings. Br J Radiol 2018; 91:20170702. [PMID: 29227144 PMCID: PMC6223153 DOI: 10.1259/bjr.20170702] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/16/2017] [Accepted: 12/01/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine the clinical, radiographic, and endoscopic findings of sleeve stenosis after sleeve gastrectomy and to correlate treatment with outcomes. METHODS We identified 43 patients who underwent barium studies to evaluate upper GI symptoms after laparoscopic sleeve gastrectomy. The clinical, radiographic, and endoscopic findings were reviewed and correlated with treatment and outcomes. RESULTS 26 patients (60%) had sleeve stenoses. All stenoses appeared as short segments of smooth, tapered narrowing, with a mean length of 8.0 mm and mean width of 7.5 mm, and 24 (92%) were located in the proximal or distal third of the sleeve. 23 patients (88%) had upstream dilation, and 1 (4%) had retained food proximal to the stenosis. 23 (70%) of 33 patients with obstructive symptoms and 3 (30%) of 10 without obstructive symptoms had sleeve stenoses. Endoscopy revealed sleeve stenosis in 8 (67%) of 12 patients with radiographic stenosis. Endoscopic dilation resulted in improvement/resolution of symptoms in seven (88%) of 8 patients. CONCLUSION Sleeve stenosis after sleeve gastrectomy was characterized radiographically by a short segment of smooth, tapered narrowing, typically in the proximal or distal third of the sleeve. Approximately, 70% of patients with obstructive symptoms and 30% with non-obstructive symptoms had sleeve stenosis. One-third of radiographically diagnosed stenoses were not seen at endoscopy. The barium study, therefore, is a useful test for sleeve stenosis in patients with obstructive or nonobstructive symptoms after sleeve gastrectomy. Advances in knowledge: This article describes the appearance and location of sleeve stenoses after laparoscopic sleeve gastrectomy and the clinical presentation and treatment options for these patients.
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Affiliation(s)
- Jennifer L Levy
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Marc S Levine
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen E Rubesin
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Noel N Williams
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Clayton RD, Carucci LR. Imaging following bariatric surgery: roux-en-Y gastric bypass, laparoscopic adjustable gastric banding and sleeve gastrectomy. Br J Radiol 2018; 91:20180031. [PMID: 29869916 PMCID: PMC6223156 DOI: 10.1259/bjr.20180031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 12/13/2022] Open
Abstract
Morbid obesity is an increasing health problem, and bariatric surgery is a popular treatment option. Radiologists must be familiar with performing and interpreting studies in this patient population. The typical post-operative findings of the Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG) procedures on upper gastrointestinal (UGI) series and computerized tomography (CT) are presented. An overview of the potential complications is provided in addition to a description of potential pitfalls in interpreting these studies.
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Affiliation(s)
- Ryan D Clayton
- Department of Radiology, VCU Health System, Richmond, VA, USA
| | - Laura R Carucci
- Department of Radiology, VCU Health System, Richmond, VA, USA
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Moomjian LN, Clayton RD, Carucci LR. A Spectrum of Entities That May Mimic Abdominopelvic Abscesses Requiring Image-guided Drainage. Radiographics 2018; 38:1264-1281. [PMID: 29995617 DOI: 10.1148/rg.2018170133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A variety of entities may mimic drainable abscesses. This can lead to misdiagnosis of these entities, unnecessary percutaneous placement of a pigtail drainage catheter, other complications, and delay in appropriate treatment of the patient. Types of entities that may mimic drainable abscesses include neoplasms (lymphoma, gallbladder cancer, gastrointestinal stromal tumor, ovarian cancer, mesenteric fibromatosis, ruptured mature cystic teratoma, recurrent malignancy in a surgical bed), ischemia/infarction (liquefactive infarction of the spleen, infarcted splenule), diverticula (calyceal, Meckel, and giant colonic diverticula), and congenital variants (obstructed duplicated collecting system). Postoperative changes, including expected anatomy after urinary diversion or Roux-en-Y gastric bypass and small bowel resection, may also pose a diagnostic challenge. Nonpyogenic infections (Mycobacterium tuberculosis, Mycobacterium avium complex, echinococcal cysts) and inflammatory conditions such as xanthogranulomatous pyelonephritis and gossypiboma could also be misinterpreted as drainable fluid collections. Appropriate recognition of these entities is essential for optimal patient care. This article exposes radiologists to a variety of entities for which percutaneous drainage may be requested, but is not indicated, and highlights important imaging findings associated with these entities to facilitate greater diagnostic accuracy and treatment in their practice. ©RSNA, 2018.
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Affiliation(s)
- Lauren N Moomjian
- From the Department of Radiology, Virginia Commonwealth University Medical Center, 1250 E Marshall St, PO Box 980615, Richmond, VA 23298
| | - Ryan D Clayton
- From the Department of Radiology, Virginia Commonwealth University Medical Center, 1250 E Marshall St, PO Box 980615, Richmond, VA 23298
| | - Laura R Carucci
- From the Department of Radiology, Virginia Commonwealth University Medical Center, 1250 E Marshall St, PO Box 980615, Richmond, VA 23298
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Alban EAD, García CA, Ospina LM, Munevar HE. Imaging after Bariatric Surgery: When Interpretation Is a Challenge, from Normal to Abnormal. Obes Surg 2018; 28:2923-2931. [DOI: 10.1007/s11695-018-3334-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Turrentine FE, Mehaffey JH, Mehaffey RL, Mullen MG, Schirmer BD, Hallowell PT. Patient Reported Outcomes 10 years After Roux-en-Y Gastric Bypass. Obes Surg 2018; 27:2253-2257. [PMID: 28303505 DOI: 10.1007/s11695-017-2641-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Following weight-loss surgery, patients who failed to achieve or sustain weight loss have nevertheless reported high satisfaction with their long-term bariatric experience. Understanding this phenomenon better will likely improve patients' experiences. OBJECTIVE The purpose of this study was to explore patients' long-term experiences following bariatric surgery. SETTING A 604-bed academic health system in the USA. METHODS Participants rated satisfaction and shared spontaneous comments regarding their gastric bypass experience. A phenomenological mode of inquiry explored participants' experiences. Transcribed phrases were categorized and themes identified. RESULTS In a 2004 surgical cohort, with 55% (155/281) participation, 99% of participants rated bariatric experience satisfaction (mean score 8.4) and 74% (115/155) shared comments regarding experiences. Responses were categorized as positive (63% 72/115), neutral (25% 29/115), or negative (12% 14/115). Satisfaction, Appreciation, and Gratefulness emerged as themes from positive comments, with 8% (6/72) explicitly acknowledging amount of weight loss achieved. Twenty-five percent (18/72) spontaneously mentioned undergoing surgery again or recommending the procedure to others. Neutral comments contained the themes of Reflection, Acknowledgment, and Wistfulness. Themes of Dissatisfaction, Disappointment, and Regret emerged from negative comments. Forty-three percent (6/14) of negative comments remarked on regaining weight or not reaching goal weight. Twenty-one percent (3/14) of negative comments explicitly stated regret at having undergone surgery. CONCLUSIONS Participants readily shared comments regarding their gastric bypass experience. Exploring themes provided insight into patients' satisfaction with bariatric surgery even when weight-loss goals were not met and conversely substantial dissatisfaction even when weight loss occurred. This study underscores the importance of understanding the patients' long-term experience following bariatric surgery.
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Affiliation(s)
- Florence E Turrentine
- Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908, USA.
| | - James H Mehaffey
- Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908, USA
| | - Rachel L Mehaffey
- Department of Internal Medicine, University of Virginia, Charlottesville, VA, USA
| | - Matthew G Mullen
- Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908, USA
| | - Bruce D Schirmer
- Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908, USA
| | - Peter T Hallowell
- Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908, USA
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Morandeira C, Bárcena M, Bilbao A, Pérez M, Ibáñez A, Isusi M, Lecumberri G. Studying the complications of bariatric surgery with intravenous contrast-enhanced multidetector computed tomography. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Morandeira C, Bárcena MV, Bilbao A, Pérez M, Ibáñez AM, Isusi M, Lecumberri G. Studying the complications of bariatric surgery with intravenous contrast-enhanced multidetector computed tomography. RADIOLOGIA 2018; 60:143-151. [PMID: 29395108 DOI: 10.1016/j.rx.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 12/04/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To review the complications of bariatric surgery and their diagnosis with intravenous contrast-enhanced multidetector computed tomography (MDCT). MATERIAL AND METHODS We retrospectively studied all patients who underwent gastric bypass or sleeve gastrectomy at our center during 2013 or 2014. We classified complications into early complications (appearing within 30 days of the intervention) and late complications. RESULTS We reviewed 155 cases and found 24 complications in 22 patients: 16 early complications (7 intraperitoneal hematomas, 5 anastomotic dehiscences, 2 intestinal obstructions, and 2 external hernias) and 8 late complications (3 internal hernias, 3 intestinal perforations, and 2 marginal ulcers). Two patients died. All of these complications were diagnosed with intravenous contrast-enhanced MDCT, except one, which required a barium transit study. CONCLUSION The rate of complications in bariatric surgery is high and the associated mortality is not negligible. Radiologists need to know the normal findings in these patients so they can quickly identify possible complications, most of which can be diagnosed with intravenous contrast-enhanced MDCT.
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Affiliation(s)
- C Morandeira
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, España.
| | - M V Bárcena
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, España
| | - A Bilbao
- Unidad de investigación, Hospital Universitario Basurto, Bilbao, España
| | - M Pérez
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, España
| | - A M Ibáñez
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, España
| | - M Isusi
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, España
| | - G Lecumberri
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, España
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Weiss J, Pomschar A, Rist C, Neumaier K, Li M, Flatz W, Thierfelder K, Notohamiprodjo M. Feasibility of optimized ultralow-dose pulsed fluoroscopy for upper gastrointestinal tract examinations: a phantom study with clinical correlation. Radiol Med 2017; 122:822-828. [DOI: 10.1007/s11547-017-0793-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
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50
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Hyperirritable stomach as a cause of obstructive symptoms after sleeve gastrectomy: clinical and radiographic findings. Clin Imaging 2017; 47:118-123. [PMID: 28946102 DOI: 10.1016/j.clinimag.2017.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/26/2017] [Accepted: 09/06/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE To characterize clinical and radiographic features of a hyperirritable stomach after sleeve gastrectomy. MATERIALS/METHODS Radiology reports revealed that 10/76 patients (13%) with obstructive symptoms after sleeve gastrectomy had a hyperirritable stomach. RESULTS All 10 patients presented with nausea, vomiting, and/or regurgitation. All 10 had emesis on barium studies in the absence of gastric outlet obstruction, gastroparesis, or small bowel obstruction/ileus. Five had extraintestinal causes of nausea/vomiting. Eight had improvement/resolution of symptoms on medical treatment. CONCLUSION In 13% of patients with nausea/vomiting after sleeve gastrectomy, barium studies revealed a hyperirritable stomach, which likely is multifactorial and self-limited in most patients.
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