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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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A review of commonly performed bariatric surgeries: Imaging features and its complications. Clin Imaging 2020; 72:122-135. [PMID: 33232899 DOI: 10.1016/j.clinimag.2020.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/13/2020] [Accepted: 11/08/2020] [Indexed: 01/15/2023]
Abstract
Obesity is a disease that has achieved the level that can be considered an epidemic. According to the National Center for Health Statistics data, the prevalence of obesity has increased from 30.5% in 1999-2000 to 42.4% in 2017-2018. During the same period, severe obesity has increased from 4.7% to 9.2%. With the growing prevalence of obesity, related conditions such as coronary artery disease, diabetes, and strokes have also become more prevalent. In the past few years, the need for bariatric surgeries such as laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic adjustable gastric banding has increased considerably. With an increasing number of bariatric surgeries, multiple postoperative complications have become common. In this review, we have attempted to describe normal postsurgical anatomical findings after bariatric surgeries and pictorial review of a few common postoperative complications.
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Abstract
Obesity and its association with long-term health problems constitutes one of the major challenges in medicine. Though diet regulation and exercise are the primary treatment strategies, surgery is the most reliable long-term solution. Although bariatric surgical complications continue to decline, prompt recognition is essential to optimize patient outcomes. Despite their relative rarity, it is important to recognize thoracic complications, as several of these can result in severe morbidity and mortality. This article describes common bariatric surgical procedures performed, their expected postoperative appearances, and intrathoracic complications.
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Scharitzer M, Pokieser P. Radiology of the Lower Esophageal Sphincter and Stomach in Patients with Swallowing Disorders. Dysphagia 2017. [DOI: 10.1007/174_2017_115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Complications of laparoscopic adjustable gastric banding (LAGB) are well documented including migration, erosion, prolapse, infection, pouch dilatation, and gastric perforation. Band prolapse within the first 5 years after LAGB is observed in about 5% of cases, requiring an operative procedure. Here we report our experience of endoscopic treatment of band prolapses. From December 2007 to December 2013, 1,347 consecutive patients (202 male, 1,145 female) underwent LAGB; 47 patients had band prolapses and 7 were treated by endoscopy. All patients were women (median age, 34 years). The mean preoperative body mass index was 38.3 ± 2.9 kg/m2. The mean duration to band prolapse after LAGB was 10.6 ± 5.6 months. The mean duration of endoscopy was 12 ± 3 min. One patient had recurrence of the prolapse 3 months after the first endoscopy and was treated by endoscopy again. There was no operative procedure required and no mortality. Endoscopic treatment of band prolapses is effective without the need for an operative procedure.
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Levine MS, Carucci LR. Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology 2014; 270:327-41. [PMID: 24471382 DOI: 10.1148/radiol.13122520] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Obesity is a disease that has reached epidemic proportions in the United States and around the world. During the past 2 decades, bariatric surgery has become an increasingly popular form of treatment for morbid obesity. The most common bariatric procedures performed include laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy. Fluoroscopic upper gastrointestinal examinations and abdominal computed tomography (CT) are the major imaging tests used to evaluate patients after these various forms of bariatric surgery. The purpose of this article is to present the surgical anatomy and normal imaging findings and postoperative complications for these bariatric procedures at fluoroscopic examinations and CT. Complications after Roux-en-Y gastric bypass include anastomotic leaks and strictures, marginal ulcers, jejunal ischemia, small bowel obstruction, internal hernias, intussusception, and recurrent weight gain. Complications after laparoscopic adjustable gastric banding include stomal stenosis, malpositioned bands, pouch dilation, band slippage, perforation, gastric volvulus, intraluminal band erosion, and port- and band-related problems. Finally, complications after sleeve gastrectomy include postoperative leaks and strictures, gastric dilation, and gastroesophageal reflux. The imaging features of these various complications of bariatric surgery are discussed and illustrated.
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Affiliation(s)
- Marc S Levine
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (M.S.L.); and Department of Radiology, VCU Medical Center, Richmond, VA (L.R.C.)
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Ni Mhuircheartaigh J, Abedin S, Bennett AE, Tyagi G. Imaging Features of Bariatric Surgery and Its Complications. Semin Ultrasound CT MR 2013; 34:311-24. [DOI: 10.1053/j.sult.2013.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Sonavane SK, Menias CO, Kantawala KP, Shanbhogue AK, Prasad SR, Eagon JC, Sandrasegaran K. Laparoscopic Adjustable Gastric Banding: What Radiologists Need to Know. Radiographics 2012; 32:1161-78. [DOI: 10.1148/rg.324115177] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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9
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Ayloo SM, Buchs NC, Bianco FM, Giulianotti PC. Cost and validity of early postoperative contrast swallow after laparoscopic adjustable gastric banding. Surg Obes Relat Dis 2012; 8:176-80. [DOI: 10.1016/j.soard.2011.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/26/2010] [Accepted: 02/02/2011] [Indexed: 11/17/2022]
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Szydłowski K, Michalik M, Pawlak M, Bobowicz M, Frask A. Band misplacement: a rare complication of laparoscopic adjustable gastric banding. Wideochir Inne Tech Maloinwazyjne 2012; 7:40-4. [PMID: 23255999 PMCID: PMC3516960 DOI: 10.5114/wiitm.2011.25930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 01/23/2011] [Accepted: 09/08/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Laparoscopic adjustable gastric banding (LAGB) is considered to be a very effective minimally invasive procedure for treating morbidly obese patients. Nevertheless, there are numerous complications that a good surgeon should be aware of. Most of them have been widely presented in the literature. AIM In this study we would like to focus on the rare but important complication which is ante-gastric positioning of the band. MATERIAL AND METHODS Between January 2005 and May 2008, 122 patients (88 female and 34 male) with mean body mass index (BMI) of 48.5 kg/m(2) (range 35-80 kg/m(2)) underwent LAGB procedure. The average time of hospitalization was 2.47 days. The first radiological control with band calibration was performed 6 weeks after the operation. Consecutive follow-up depended on the percent excess weight loss (EWL%). RESULTS Of the 122 patients, 4 (3.3%) presented herein had a band misplaced in the ante-gastric position. There were three out of five surgeons who faced complications of this type. The most and the least experienced team members avoided misplacing the band. Two physicians encountered it at the beginning of their learning curve, and for one it was not related to the process of education. Among other postoperative complications there were two incidents of band slippage, 2 patients had their port localization corrected and in one case drain disconnection occurred. There were no mortalities. CONCLUSIONS Ante-gastric positioning of the band was the most common cause of obesity surgery failure in our group of patients. It was very difficult to recognize during the typical postoperative checkups; hence there arose a question whether it has been disregarded in other studies.
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Affiliation(s)
- Konrad Szydłowski
- Department of General and Vascular Surgery, Ceynowa Hospital, Wejherowo, Poland
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11
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Labib PLZ, Agrawal S. An unusual case of significant weight loss following malposition of a laparoscopic adjustable gastric band. Obes Facts 2012; 5:625-8. [PMID: 22964980 DOI: 10.1159/000342817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 01/28/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Malposition or misplacement of gastric bands is a rare but recognised early complication of gastric band surgery. Malposition of the band would not normally result in significant weight loss after surgery. CASE REPORT To our knowledge, we report the first case in the English literature of a malpositioned gastric band encircling the pericardial fat pad only, who presented with delayed symptoms of dysphagia and gastro-oesophageal reflux resulting in significant weight loss (>60% of excess body weight) approximately 6 years after primary surgery. The patient underwent a water-soluble contrast study with antero-posterior views which was suggestive of a slipped band. However, on laparoscopy the band was found to be encircling the pericardial fat pad. CONCLUSION We suggest that all contrast swallow studies for patients presenting with symptoms of gastric band slippage should include lateral views to exclude gastric band malposition, irrespective of the time of onset of symptoms after primary surgery.
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Karpitschka M, Lang R, Jauch KW, Reiser MF, Weckbach S. [Bariatric surgery and associated complications: radiological imaging]. Radiologe 2011; 51:352-65. [PMID: 21512763 DOI: 10.1007/s00117-010-2086-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Obesity is an increasing problem faced by the healthcare system. In managing obesity, bariatric surgery is becoming more important with evidence showing a reduction in long-term morbidity and mortality. There are special challenges faced by the radiology department in providing an imaging service for this population of patients, from technical requirements through to the interpretation of post-surgical images. This article provides an overview of the most frequently performed procedures, normal postoperative imaging findings and the appearance of common complications.
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Affiliation(s)
- M Karpitschka
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, München, Deutschland
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The surgical management of obesity with emphasis on the role of post operative imaging. Biomed Imaging Interv J 2011; 7:e8. [PMID: 21655117 PMCID: PMC3107690 DOI: 10.2349/biij.7.1.e8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 10/14/2010] [Accepted: 11/06/2010] [Indexed: 12/21/2022] Open
Abstract
The role of surgery in the morbidly obese is becoming more prominent. There are a variety of surgical approaches which can be used and radiology plays a crucial role in post operative follow up, particularly in the management of complications. Many general radiologists remain unfamiliar with both the normal and abnormal appearances after bariatric surgery and this pictorial review aims to bridge this gap.
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Shah S, Shah V, Ahmed AR, Blunt DM. Imaging in bariatric surgery: service set-up, post-operative anatomy and complications. Br J Radiol 2010; 84:101-11. [PMID: 21045066 DOI: 10.1259/bjr/18405029] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Obesity is an increasingly prevalent and costly problem faced by the healthcare system. The role of bariatric surgery in managing obesity has also increased with evidence showing a reduction in long-term morbidity and mortality. There are unique challenges faced by the radiology department in providing an imaging service for this population of patients, from technical and staffing requirements through to the interpretation of challenging post-surgical images. We describe these challenges and provide an overview of the most frequently performed procedures, normal post-operative imaging findings and the appearance of common complications.
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Affiliation(s)
- S Shah
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK.
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15
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The “O” Sign, a Simple and Helpful Tool in the Diagnosis of Laparoscopic Adjustable Gastric Band Slippage. AJR Am J Roentgenol 2010; 195:137-41. [DOI: 10.2214/ajr.09.3933] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kroh M, Brethauer S, Duelley N, Rogula T, Schauer P, Chand B. Surgeon-performed fluoroscopy conducted simultaneously during all laparoscopic adjustable gastric band adjustments results in significant alterations in clinical decisions. Obes Surg 2009; 20:188-92. [PMID: 19763706 DOI: 10.1007/s11695-009-9972-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 09/01/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little data exists regarding filling regimens for laparoscopic adjustable gastric bands (LAGB). In addition to patient symptoms and weight changes, we have instituted surgeon-performed, real-time fluoroscopic evaluation in our clinical decision making during all band adjustments. OBJECTIVE Our hypothesis is that surgeon-performed, real-time contrast fluoroscopy conducted routinely during all LAGB adjustment results in significant deviations in clinical care. SETTING The study is set at the Academic Referral Center, United States METHODS Fifty-two consecutive patients who underwent LAGB and presented for adjustment were given a questionnaire evaluating obstructive symptoms. The patient's weight loss history was also reviewed. Each patient underwent real-time fluoroscopy performed by the surgeon during adjustment. Data were recorded and compared to final decision to fill, make no adjustment, or remove fluid. RESULTS Patients were, on average, at post-operative visit 5. Sixty-three percent of patients received a fill, 31% had no change, and 6% had fluid removed. On the questionnaire, 15% of patients noted reflux, 10% had dysphagia, and 8% had regurgitation. Eighty percent of patients requested a fill. Thirty-one percent had an abnormality noted on fluoroscopy. Fifteen percent of patients demonstrated esophageal dilation, 15% had a delay of greater than 5 s, 19% had reflux of contrast. Three patients had band displacements on imaging. Additionally, six patients (12%) were not filled based on fluoroscopic findings alone, not predicted by either the survey or historical weight loss. CONCLUSION Surgeon-performed, real-time, fluoroscopy during LAGB adjustment results in significant changes in clinical care that are not predicted by history and weight loss alone. Routine fluoroscopic imaging altered the course of management in 12% of patients and identified three asymptomatic displaced bands.
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Affiliation(s)
- Matthew Kroh
- Cleveland Clinic Bariatric and Metabolic Institute, Cleveland, OH, USA.
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Radiological features of complications of laparoscopic adjustable gastric banding. Radiol Med 2009; 114:802-10. [DOI: 10.1007/s11547-009-0389-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 10/24/2008] [Indexed: 10/20/2022]
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Louri N, Darwish B, Alkhalifa K. Stoma obstruction after laparoscopic adjustable gastric banding for morbid obesity: report of two cases and treatment options. Obes Rev 2008; 9:518-21. [PMID: 18721232 DOI: 10.1111/j.1467-789x.2008.00517.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Laparoscopic adjustable gastric band is one of the surgical options available for morbid obesity in the current century. Its popularity is gained by its proven efficacy with a reported low incidence of the intraoperative as well as the postoperative complications. Stomal obstruction post-laparoscopic adjustable gastric band (LAGB) has been under reported in the English literature. We report this complication in two patients and discuss two different simple modalities of treatment. Post-LAGB complications are numerous, dealing with their complications have a steeping curve. Educating the patients postoperatively in regard to food ingestion manner is a must and should prevent such complication.
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Affiliation(s)
- N Louri
- Department of General Surgery, Bahrain Defence Force - Royal Medical Services Hospital, East Riffa, Bahrain Kingdom.
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Pomerri F, Foletto M, Bernante P, Tonello E, Muzzio PC. Radiological assessment of complications after laparoscopic suprabursal adjustable gastric banding for morbid obesity. Obes Surg 2008; 19:146-152. [PMID: 18685904 DOI: 10.1007/s11695-008-9632-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 06/27/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the clinical impact of radiological assessment on delivery of therapy in patients with laparoscopic adjustable gastric banding for morbid obesity who have developed gastroesophageal symptoms or have inadequate excess weight loss. METHODS Institutional review board approval and informed consent were obtained from all patients. Suprabursal banding was performed in 373 patients who underwent 869 upper gastrointestinal series. The control group comprised 59 asymptomatic subjects from the study population with satisfactory weight loss at follow-up. RESULTS There were no intra-operative deaths or gastric perforations. A small gastric pouch was found above the band in 13 (22.03%) of the 59 control subjects; the upper limit of the gastric pouch volume was 9.85 ml (mathematical formula for a sphere used). The main postoperative complications included: 21 of 373 (5.63%) gastric portions above the band with a mean volume of 137.98 ml and narrowed stoma of 0.99 mm; 15 of 373 (4.02%) gastric portions above the band with a mean volume of 33.27 ml and open stoma of 4.95 mm; and 16 of 373 (4.28%) tubing disconnection and displacement into the peritoneal cavity. Twenty-one of 21 narrowed-stoma and eight of 15 open-stoma gastric portions underwent repeat surgery, upward herniation of the stomach (from below the band) being found in all 29 cases. CONCLUSION Our main findings following the use of the suprabursal approach for surgical band positioning suggest that repeat surgery may be worthwhile for all gastric upper portions >10 ml in patients with gastroesophageal symptoms or inadequate excess weight loss.
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Affiliation(s)
- Fabio Pomerri
- Department of Medical-Diagnostic Sciences and Special Therapies, Radiology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy. .,The Veneto Institute of Oncology (IOV-IRCCS), via Gattamelata 64, 35128, Padua, Italy.
| | - Mirto Foletto
- 2nd Institute of Clinical Surgery, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Paolo Bernante
- 2nd Institute of Clinical Surgery, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Elisa Tonello
- Department of Medical-Diagnostic Sciences and Special Therapies, Radiology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Pier Carlo Muzzio
- Department of Medical-Diagnostic Sciences and Special Therapies, Radiology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.,The Veneto Institute of Oncology (IOV-IRCCS), via Gattamelata 64, 35128, Padua, Italy
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Prosch H, Tscherney R, Kriwanek S, Tscholakoff D. Radiographical imaging of the normal anatomy and complications after gastric banding. Br J Radiol 2008; 81:753-7. [PMID: 18508872 DOI: 10.1259/bjr/95353541] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Laparoscopic adjustable gastric banding is a surgical procedure that is increasingly being performed for the treatment of morbid obesity. As with any intervention, gastric banding is not free from complications. Complications after gastric banding can be divided into early and late complications. Early complications include band malposition and perforation of the stomach. Late complications comprise pouch dilatation, intraluminal band penetration and oesophageal dilatation. Understanding the principles of the intervention is essential for both the interpretation of the resulting radiographical findings and the diagnosis of potential complications. We report on the normal anatomy and the most frequent complications seen after gastric banding.
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Affiliation(s)
- H Prosch
- Department of Radiology, Rudolfstiftung Hospital, Juchgasse 25, 1030 Vienna, Austria
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21
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Mechanical versus suture fixation of the port in adjustable gastric banding procedures: a prospective randomized blinded study. Surg Endosc 2008; 22:2478-84. [PMID: 18389313 DOI: 10.1007/s00464-008-9882-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 01/14/2008] [Accepted: 02/02/2008] [Indexed: 10/22/2022]
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Imaging in Bariatric Surgery: A Guide to Postsurgical Anatomy and Common Complications. AJR Am J Roentgenol 2008; 190:122-35. [DOI: 10.2214/ajr.07.2134] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Carucci LR, Turner MA, Szucs RA. Adjustable laparoscopic gastric banding for morbid obesity: imaging assessment and complications. Radiol Clin North Am 2007; 45:261-74. [PMID: 17502216 DOI: 10.1016/j.rcl.2007.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Laparoscopic adjustable gastric banding (LAGB) is a safe and effective means of weight loss for patients who have morbid obesity. LAGB currently is the least invasive surgical treatment for morbid obesity. Radiologists must be aware of the expected postoperative imaging findings, the optimal technique for radiologic assessment, and the postoperative complications that may occur. In addition, because band-adjustment procedures often are performed fluoroscopically, the radiologist may play a direct role in the management of weight loss in patients following LAGB.
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Affiliation(s)
- Laura R Carucci
- Department of Radiology, Abdominal Imaging Section, Virginia Commonwealth University Medical Center, 1250 East Marshall Street, Main Hospital 3rd Floor, Room 3-417, P.O. Box 980615, Richmond, VA 23298-0615, USA.
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Stroh C, Manger T. Ergebnisse einer deutschlandweiten Umfrage – Komplikationen nach steuerbarem Magenband. Visc Med 2007. [DOI: 10.1159/000098161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Blachar A, Blank A, Gavert N, Metzer U, Fluser G, Abu-Abeid S. Laparoscopic Adjustable Gastric Banding Surgery for Morbid Obesity: Imaging of Normal Anatomic Features and Postoperative Gastrointestinal Complications. AJR Am J Roentgenol 2007; 188:472-9. [PMID: 17242257 DOI: 10.2214/ajr.05.0293] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this essay is to describe the normal anatomic findings after laparoscopic adjustable gastric banding surgery and the imaging findings of postoperative gastrointestinal complications. CONCLUSION With the increasing prevalence of morbid obesity, laparoscopic adjustable gastric banding surgery has evolved to be a leading surgical technique. Radiologists need to be familiar with the normal anatomic findings after laparoscopic adjustable gastric banding surgery and with the imaging findings of postoperative complications.
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Affiliation(s)
- Arye Blachar
- Department of Radiology, Tel Aviv Sourasky Medical Center, 6 Weizman St., Tel Aviv 64239, Israel.
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Stroh C, Hohmann U, Schramm H, Manger T. 10-Jahres-Ergebnissemit dem Magenband: Sind Bandversager Folge eines Fehlers? Visc Med 2007. [DOI: 10.1159/000098159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Bennett JMH, Mehta S, Rhodes M. Surgery for morbid obesity. Postgrad Med J 2007; 83:8-15. [PMID: 17267672 PMCID: PMC2599972 DOI: 10.1136/pgmj.2006.048868] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 06/02/2006] [Indexed: 12/19/2022]
Abstract
The prevalence of morbid obesity in the UK population is rising, bringing with it increased levels of cardiovascular disease, diabetes, arthritis and early mortality. The overall cost to the health service is high, and is set to increase over the coming decades as the overweight population ages. Dietary, lifestyle and pharmacological interventions offer at best reasonable, short-term weight reduction and often fail. Surgical intervention is a safe and effective means of delivering marked long-term weight reduction. This article compares and contrasts the options available for surgical treatment of morbid obesity based on a review of the current literature.
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Affiliation(s)
- John M H Bennett
- Department of Upper Gastrointestinal Surgery, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
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Blachar A, Federle MP, Pealer KM, Abu Abeid S, Graif M. Radiographic manifestations of normal postoperative anatomy and gastrointestinal complications of bariatric surgery, with emphasis on CT imaging findings. Semin Ultrasound CT MR 2006; 25:239-51. [PMID: 15272548 DOI: 10.1053/j.sult.2004.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Recently, there has been a tremendous increase in the frequency of utilization of surgery to control morbid obesity that is very common and increasing in incidence in Western industrialized nations. Imaging plays an important role in the evaluation and management of patients before and after bariatric surgery. In this article, we discuss the imaging findings relating to bariatric procedures, focusing on the role of computed tomography (CT) in the evaluation of normal postoperative anatomy and gastrointestinal complications.
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Affiliation(s)
- Arye Blachar
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel Aviv University, Sackler School of Medicine, Tel-Aviv, Israel.
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Pierredon-Foulongne MA, Nocca D, Fabre JM, Bruel JM, Gallix BP. [Laparoscopic adjustable gastric banding for morbid obesity: clinical and radiographic follow-up]. ACTA ACUST UNITED AC 2006; 86:1763-72. [PMID: 16333225 DOI: 10.1016/s0221-0363(05)81520-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the role of imaging for follow-up after treatment of morbid obesity by laparoscopic adjustable gastric banding (LAGB). PATIENTS AND METHODS Since 1996, more than 1,000 patients underwent gastric banding using 5 different types of devices. Our experience is based on a retrospective study (from September 1996 to September 2002) concerning 663 consecutive patients who underwent LAGB: 114 Lapband system (LB) and 549 Swedish adjustable gastric banding (SAGB). Upper gastrointestinal series were performed within 24-48 hours after surgery in all patients. Radiological examination was also used to detect complications and to adjust gastric band. RESULTS The five types of gastric band are easily identified on plain films. Early and late complications are illustrated: pouch dilatation, slippage, band migration, rotation of the port, and system disconnection. Radiological criteria for adjustment of gastric band are explained on the basis of barium studies performed before and after any modification of the stoma size. CONCLUSION In patients treated with LAGB for morbid obesity, radiology plays an important role in evaluating early and late complications.
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Leidel BA, Kanz KG, Mutschler W. [Evidence based diagnostic procedures for the determination of suspected blunt cervical spine injuries. Development of an algorithm]. Unfallchirurg 2006; 108:905-6, 908-19. [PMID: 15999250 DOI: 10.1007/s00113-005-0968-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study was to present existing publications, describing various diagnostic procedures as well as considering the evidence supporting them, to develop a recommendation for diagnosis. MATERIAL AND METHODS We reviewed relevant publications between 1966 and 2004 by a systemic literature search in MEDLINE, EMBASE, National Guideline Clearinghouse, Cochrane Library as well as a manual reference search. Keywords were cervical spine, cervical vertebrae, spinal, spinal cord, injury, trauma, fracture, dislocation, imaging, radiography, flexion, extension, fluoroscopy, computed tomography, computed scanning, and magnetic resonance imaging. The selected search results were then classified into levels of evidence. RESULTS From among a total of 10,000 publications, 137 relevant publications were stringently reviewed. The level of evidence is on the whole limited due to deficit data; therefore, only class II-III recommendations are possible. We developed an algorithm for the diagnostic approach to suspected trauma of the cervical spine. This clinical algorithm displays the complex diagnosis of cervical spine injury in a clear and logically structured process. CONCLUSIONS The diagnostic algorithm for cervical spine injury meets the presently required standards and maximizes care for the newly injured. The development, which can be followed using evidence-based medicine, is transparent and therefore aids the decision process when choosing an adequate diagnostic procedure.
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Affiliation(s)
- B A Leidel
- Chirurgische Klinik und Poliklinik Innenstadt, Klinikum der Universität München.
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Abstract
BACKGROUND Adjustable gastric banding is a popular bariatric operation in Europe. About 1500 patients per year undergo a such procedures in Germany. Clinical data on the rate of long-term complications such as pouch dilatation, slippage, and band migration are available in only a few long-term studies with small numbers of patients. Meta-analyses report on comordities and reduction in weight. The rate and management of long-term complications were examined at this inquiry. METHODS Ninety hospitals were asked about rates of band implantation, follow-up, and complications. Thirty-eight hospitals (42.2%) participated in the study. The management of complications including slippage, pouch dilatation, and band migration was analyzed. RESULTS At 35 hospitals, 4138 patients underwent gastric banding procedures in 25 hospitals over more than 5 years. The mean follow-up rate is presently 85.3%. Long-term complications were described in 8.6% of the patients. Pouch dilatation occurred in 5.0%, slippage in 2.6%, and band migration in 1.0%. CONCLUSIONS Laparoscopic adjustable gastric banding can effectively achieve weight loss. However, band-related and functional complications influence late outcome. The rate of long-term complications was equivalent to that already in the literature.
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Affiliation(s)
- C Stroh
- Departement für Allgemein- und Visceralchirurgie SRH Wald-Klinikum Gera gGmbH, Akademisches Lehrkrankenhaus der Friedrich-Schiller-Universität Jena
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Mehanna MJ, Birjawi G, Moukaddam HA, Khoury G, Hussein M, Al-Kutoubi A. Complications of Adjustable Gastric Banding, a Radiological Pictorial Review. AJR Am J Roentgenol 2006; 186:522-34. [PMID: 16423963 DOI: 10.2214/ajr.04.0655] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to review the radiologic appearance of complications of the adjustable gastric band. CONCLUSION Continuous progress in surgical technique of adjustable gastric banding and the increasing experience of surgeons have decreased the rate of complications. However, because different complications may have the same clinical presentation but require different treatment, to give a definitive diagnosis, the radiologist must be aware of the surgical procedures and possible sequelae.
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Affiliation(s)
- Mayssoun J Mehanna
- Department of Diagnostic Radiology, American University of Beirut Medical Center, PO Box 11-0236, Beirut, Lebanon
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Sauerland S, Angrisani L, Belachew M, Chevallier JM, Favretti F, Finer N, Fingerhut A, Garcia Caballero M, Guisado Macias JA, Mittermair R, Morino M, Msika S, Rubino F, Tacchino R, Weiner R, Neugebauer EAM. Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 2004; 19:200-21. [PMID: 15580436 DOI: 10.1007/s00464-004-9194-1] [Citation(s) in RCA: 238] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2004] [Accepted: 08/19/2004] [Indexed: 12/11/2022]
Abstract
BACKGROUND The increasing prevalence of morbid obesity together with the development of laparoscopic approaches has led to a steep rise in the number of bariatric operations. These guidelines intend to define the comparative effectiveness and surrounding circumstances of the various types of obesity surgery. METHODS A consensus panel representing the fields of general/endoscopic surgery, nutrition and epidemiology convened to agree on specific questions in obesity surgery. Databases were systematically searched for clinical trial results in order to produce evidence-based recommendations. Following two days of discussion by the experts and a plenary discussion, the final statements were issued. RECOMMENDATIONS After the patient's multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least 40. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. Psychiatric consultation and polysomnography can safely be restricted to patients with clinical symptoms on preoperative screening. Adjustable gastric banding (GB), vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) are all effective in the treatment of morbid obesity, but differ in degree of weight loss and range of complications. The choice of procedure therefore should be tailored to the individual situation. There is evidence that a laparoscopic approach is advantageous for LAGB, VBG, and GB (and probably also for BPD). Antibiotic and antithromboembolic prophylaxis should be used routinely. Patients should be seen 3 to 8 times during the first postoperative year, 1 to 4 times during the second year and once or twice a year thereafter. Outcome assessment after surgery should include weight loss and maintainance, nutritional status, comorbidities and quality-of-life.
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Affiliation(s)
- S Sauerland
- European Association for Endoscopic Surgery, Post Office Box 335, Veldhoven, AH, 5500, The Netherlands
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Korenkov M, Sauerland S, Yücel N, Köhler L, Goh P, Schierholz J, Troidl H. Port function after laparoscopic adjustable gastric banding for morbid obesity. Surg Endosc 2003; 17:1068-71. [PMID: 12728371 DOI: 10.1007/s00464-002-9190-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2002] [Accepted: 01/20/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LGB) has gained wide popularity, but information on port function is limited. METHODS In a prospective nonrandomized study, we analyzed port function and related symptoms in 50 consecutive patients with severe obesity. All patients underwent LGP in a five trocar technique. In 11 patients, the port was placed subcutaneously in the subxiphoid region. In 39 patients, the port was implanted in the left upper abdomen. Mean duration of follow-up was 2.8 years. RESULTS Patients (12 males and 38 females) had an initial body mass index (BMI) of 47.1 kg/m2. Puncturing the subxiphoidal port was without problems in all 11 patients. However, seven women reported pain and inconvenience when wearing a brassiere. Two underwent port reimplantation in the left upper abdomen (one due to infection; one due to pain). Among the 39 patients with abdominal port implantation, nine patients required port correction (two of them twice). The causes were port dislocation (four cases), difficult puncturing (three), tube leakage (three), and infection (one). CONCLUSION The high number of complications suggests that the port is the Achilles' heel of LGB. Ports at the subxiphoid site were easier to puncture, but frequently caused pain in female patients.
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Affiliation(s)
- M Korenkov
- Surgical Clinic, 2nd Department of Surgery, University of Cologne, Germany.
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