Radiological assessment of gastroplasty and gastric bypass surgery

Percutaneous computed tomography-guided gastric remnant access after laparoscopic Roux-en-Y gastric bypass

BACKGROUND

The bypassed portion of the stomach is difficult to access and evaluate after Roux-en-Y gastric bypass. Access to the excluded stomach may be needed for nutritional support or decompression owing to acute distension and obstruction. We report our experience with percutaneous, computed tomography (CT)-guided gastrostomy tube placement into the gastric remnant after laparoscopic Roux-en-Y gastric bypass (LRYGB).

METHODS

Of 569 consecutive LRYGB procedures performed, 9 patients underwent successful percutaneous, CT-guided gastrostomy placement. One additional patient was referred from another facility. We reviewed the indications, interval from surgery to the intervention, interval to removal, complications, and success or outcome of the procedure in our patient population.

RESULTS

Ten patients underwent percutaneous, CT-guided gastric remnant gastrostomy tube placement. The indications included distended gastric remnant in 6, nutritional access in 4, and remnant drainage after leak in 1. Of the 10 patients, 2 had undergone previous gastric operations. The attempt at percutaneous gastrostomy was unsuccessful in 1 additional patient, who subsequently required laparoscopic gastrostomy (success rate 91%).

CONCLUSION

In selected patients after LRYGB, CT-guided gastrostomy tube placement is safe and efficient. It may be used to manage complications of LRYGB, serve as a bridge to definitive surgery, or offer a convenient route for enteral nutritional support.

Roux-en-Y gastric bypass surgery for morbid obesity: evaluation of postoperative extraluminal leaks with upper gastrointestinal series

PURPOSE

To retrospectively evaluate the radiographic features of extraluminal leak after Roux-en-Y gastric bypass (RYGBP) surgery at upper gastrointestinal (GI) examinations in a large series of patients and to determine morbidity and mortality in those patients with leak.

MATERIALS AND METHODS

The investigational review board approved this HIPAA-compliant study, and the need for patient informed consent was waived. Radiologic database review revealed 1202 upper GI studies performed over a 4-year period in 906 patients after RYGBP. Extraluminal leak was identified in 50 patients. Two patients with leaks that occurred before the study period were excluded. Of the remaining 48 patients, 12 were men and 36 were women (mean age, 45 years; range, 26-64 years). Surgery had been laparoscopic in 23 patients and open in 25. Upper GI studies were analyzed by two radiologists in consensus for the origin, extent, and severity of leaks and associated findings. Chart review was performed to determine clinical course, treatment, and outcome.

RESULTS

Fifty extraluminal leaks were detected in 48 of 904 patients (5.3%) at upper GI examinations. All leaks were identified within 28 days, and, in 37 of 48 patients (77%), leakage was diagnosed within 1 week of surgery. The majority of leaks (n = 37) originated from the gastrojejunal anastomosis. Leaks also occurred at the distal portion of the esophagus (n = 5), the gastric pouch (n = 5), the oversewn jejunum (n = 2), and the distal anastomosis (n = 1). Leaks extended into the left upper quadrant in 30 patients. Obstruction or ileus was present in 35 of 48 patients (73%). Leak into the excluded stomach was observed in 15 of 48 patients. The occurrence of extraluminal leak prolonged hospital stays; organ failure occurred in 14 (29%) and death in three (6%) of the 48 patients.

CONCLUSION

Extraluminal leak was identified on upper GI series in 48 of 904 patients (5.3%) after RYGBP for morbid obesity. Extraluminal leak most commonly arises from the gastrojejunal anastomosis and extends into the left upper quadrant. Extraluminal leak affects morbidity and mortality.

Radiologic evaluation following Roux-en-Y gastric bypass surgery for morbid obesity

Morbid obesity is an increasing health problem, and bariatric surgery is becoming a popular treatment option. Radiologists must be familiar with performing and interpreting studies in this patient population. The typical postoperative findings of the Roux-en-Y gastric bypass (RYGBP) procedure for morbid obesity on upper gastrointestinal (UGI) series are presented. An overview of the potential complications that may be diagnosed with contrast studies and computed tomography (CT) is provided in addition to a description of potential pitfalls in interpreting these studies.

Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings

PURPOSE

To report the complications and imaging findings in a large group of patients who underwent Roux-en-Y gastric bypass (GBP) surgery.

MATERIALS AND METHODS

Four hundred sixty-three patients were evaluated for upper gastrointestinal (GI) complications following Roux-en-Y GBP surgery. Major complications were those that required surgical or radiologic intervention and minor complications were those that resolved spontaneously. The time from surgery to complication and findings from upper GI series and computed tomography (CT) of the major complications and minor leaks were reviewed.

RESULTS

Forty-four patients had 56 major complications: 23 small-bowel obstructions (14 internal hernias and nine adhesions), 16 major leaks, 15 anastomotic strictures, and two fistulas. There were 13 minor leaks and 18 other complications. Internal hernias were late complications and had a variety of findings at upper GI series and CT. Leaks were early complications and usually originated from the gastrojejunal anastomosis; findings from upper GI series and CT demonstrated extraluminal gas, contrast material, or both. Anastomotic strictures were late complications and were diagnosed at upper GI series with rounded dilation of the pouch and delayed emptying.

CONCLUSION

Upper GI complications that required intervention occurred in 9.5% of patients. CT and upper GI series can depict most major complications.

Radiological appearances following vertical banded gastroplasty

Vertical banded gastroplasty was performed on 19 grossly obese patients. Upper gastrointestinal contrast studies were performed on all patients in the immediate post-operative period and at 3 months and 1 year in 16 and 12 patients, respectively. The immediate and long-term appearances are presented and discussed. The surgical outcome depends on pouch size, outlet diameter and staple line integrity, which are reliably demonstrated by double-contrast barium studies.

Radiologic assessment of the distal stomach and duodenum after gastric bypass: percutaneous CT-guided transcatheter technique

Following some types of gastric bypass surgery for morbid obesity the conventional barium examination fails to opacify the bypassed segments of distal stomach and duodenum. The authors describe a technique for visualization of these segments by injection of contrast material through a percutaneously inserted catheter.