Advertisement

Obesity Surgery

, Volume 19, Issue 4, pp 508–516 | Cite as

3D-MSCT Gastric Pouch Volumetry in Bariatric Surgery—Preliminary Clinical Results

  • W. K. KarczEmail author
  • S. Kuesters
  • G. Marjanovic
  • D. Sueßlin
  • E. Kotter
  • O. Thomusch
  • U. T. Hopt
  • G. Felmerer
  • M. Langer
  • T. Baumann
Modern Surgery: Technical Innovation

Abstract

Background

Insufficient weight loss or persistent abdominal complaints are reasons for revisionary operations in bariatric surgery. The selection of the secondary procedure is influenced by clinical and by patho-anatomical factors like the size of the gastric pouch. The purpose of this study was to evaluate multi-slice computed tomography (MSCT)-based volumetric assessment of gastric pouches, gastric sleeves, and anastomoses in patients after bariatric surgery.

Methods

Twenty-six patients after bariatric surgery received abdominal MSCT immediately after oral administration of an ionic contrast agent solution and intravenous administration of buthylscopalamine. Indications were insufficient weight loss after primary operation, persistent upper abdominal complaints, and decline of bariatric analysis and reporting outcomes system (BAROS) score. The gastric volumes, diameter of the gastrojejunostomy, and the proximal part of the Roux limb were measured on volume rendering images and freely angulated reformations.

Results

Evaluation of gastric volumes was successful in 25 examinations (96%). The diameters of gastrojejunostomy as well as the dimensions of the Roux limb were evaluable in all cases. After gastric bypass surgery, a pouch volume >30 ml was found in ten, a widening of the gastrojejunostomy in eight, and a dilated Roux limb in six cases. Two patients presented a combination of a wide anastomosis and a strongly dilated Roux limb. Patients after biliopancreatic diversion had gastric volumes between 210 and 840 ml. Other findings were a fistula, an intragastral stenosis, and internal hernias.

Conclusions

MSCT allows crucial patho-anatomical measurements and provides helpful information for selecting the appropriate revisionary operation after bariatric surgery.

Keywords

Bariatric surgery Gastric bypass Multi-slice CT Segmentation Volumetric assessment 

References

  1. 1.
    Karlsson J, Taft C, Ryden A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes (Lond). 2007;31(8):1248–61.CrossRefGoogle Scholar
  2. 2.
    Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.CrossRefGoogle Scholar
  3. 3.
    van Gemert WG, van Wersch MM, Greve JW, et al. Revisional surgery after failed vertical banded gastroplasty: restoration of vertical banded gastroplasty or conversion to gastric bypass. Obes Surg. 1998;8(1):21–8.CrossRefGoogle Scholar
  4. 4.
    Gawdat K. Bariatric re-operations: are they preventable? Obes Surg. 2000;10(6):525–9.CrossRefGoogle Scholar
  5. 5.
    Gagner M, Gentileschi P, Pomp A, et al. Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg. 2002;12(2):254–60.CrossRefGoogle Scholar
  6. 6.
    Favretti F, Segato G, De MF, et al. An adjustable silicone gastric band for laparoscopic treatment of morbid obesity—technique and results. Surg Technol Int. 2002;10:109–14.PubMedGoogle Scholar
  7. 7.
    Forsell P. Pouch volume, stoma diameter and weight loss in Swedish adjustable gastric banding (SAGB). Obes Surg. 1996;6(6):468–73.CrossRefGoogle Scholar
  8. 8.
    Baltasar A, Serra C, Perez N, et al. Laparoscopic sleeve gastrectomy: a multipurpose bariatric operation. Obes Surg. 2005;15(8):1124–8.CrossRefGoogle Scholar
  9. 9.
    Johnston D, Dachtler J, Sue-Ling HM, et al. The Magenstrasse and Mill operation for morbid obesity. Obes Surg. 2003;13(1):10–6.CrossRefGoogle Scholar
  10. 10.
    Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg. 2008;18:487–96.CrossRefGoogle Scholar
  11. 11.
    Weiner RA, Weiner S, Pomhoff I, et al. Laparoscopic sleeve gastrectomy—influence of sleeve size and resected gastric volume. Obes Surg. 2007;17(10):1297–305.CrossRefGoogle Scholar
  12. 12.
    Madan AK, Harper JL, Tichansky DS. Techniques of laparoscopic gastric bypass: on-line survey of American Society for Bariatric Surgery Practicing Surgeons. Surg Obes Relat Dis. 2008;4(2):166–72.CrossRefGoogle Scholar
  13. 13.
    Roberts K, Duffy A, Kaufman J, et al. Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21(8):1397–402.CrossRefGoogle Scholar
  14. 14.
    Schwartz RW, Strodel WE, Simpson WS, et al. Gastric bypass revision: lessons learned from 920 cases. Surgery 1988;104(4):806–12.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Muller MK, Wildi S, Scholz T, et al. Laparoscopic pouch resizing and redo of gastro-jejunal anastomosis for pouch dilatation following gastric bypass. Obes Surg. 2005;15(8):1089–95.CrossRefGoogle Scholar
  16. 16.
    Gagner M, Rogula T. Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg. 2003;13(4):649–54.CrossRefGoogle Scholar
  17. 17.
    Weiss HG, Kirchmayr W, Klaus A, et al. Surgical revision after failure of laparoscopic adjustable gastric banding. Br J Surg. 2004;91(2):235–41.CrossRefGoogle Scholar
  18. 18.
    Wolf AM, Falcone AR, Kortner B, et al. BAROS: an effective system to evaluate the results of patients after bariatric surgery. Obes Surg. 2000;10(5):445–50.CrossRefGoogle Scholar
  19. 19.
    Karcz WK, Baumann T, Marjanovic G, et al. To have or not to have the ring: early and late surgical complications after banded Roux-en-Y gastric bypass. Videosurgery and Other Miniinvasive Techniques. 2008;3(2):53–5.Google Scholar
  20. 20.
    Fobi MA. Placement of the GaBP ring system in the banded gastric bypass operation. Obes Surg. 2005;15(8):1196–201.CrossRefGoogle Scholar
  21. 21.
    Weber M, Muller MK, Michel JM, et al. Laparoscopic Roux-en-Y gastric bypass, but not rebanding, should be proposed as rescue procedure for patients with failed laparoscopic gastric banding. Ann Surg. 2003;238(6):827–33.CrossRefGoogle Scholar
  22. 22.
    Topart P, Becouarn G, Ritz P. Biliopancreatic diversion with duodenal switch or gastric bypass for failed gastric banding: retrospective study from two institutions with preliminary results. Surg Obes Relat Dis. 2007;3(5):521–5.CrossRefGoogle Scholar
  23. 23.
    Pareja JC, Pilla VF, Callejas-Neto F, et al. Gastric bypass Roux-en-Y gastrojejunostomy—conversion to distal gastrojejunoileostomy for weight loss failure—experience in 41 patients. Arq Gastroenterol. 2005;42(4):196–200.CrossRefGoogle Scholar
  24. 24.
    Sugerman HJ, Kellum JM, DeMaria EJ. Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity. J Gastrointest Surg. 1997;1(6):517–24.CrossRefGoogle Scholar
  25. 25.
    Fobi MA, Lee H, Igwe D, et al. Revision of failed gastric bypass to distal Roux-en-Y gastric bypass: a review of 65 cases. Obes Surg. 2001;11(2):190–5.CrossRefGoogle Scholar
  26. 26.
    Parikh M, Pomp A, Gagner M. Laparoscopic conversion of failed gastric bypass to duodenal switch: technical considerations and preliminary outcomes. Surg Obes Relat Dis. 2007;3(6):611–8.CrossRefGoogle Scholar
  27. 27.
    Gumbs AA, Margolis B, Bessler M. Laparoscopic banded-Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006;2(3):408–9.CrossRefGoogle Scholar
  28. 28.
    Flanagan L. Measurement of functional pouch volume following the gastric bypass procedure. Obes Surg. 1996;6(1):38–43.CrossRefGoogle Scholar
  29. 29.
    Forsell P, Hellers G, Laveskog U, et al. Validation of pouch size measurement following the Swedish adjustable gastric banding using endoscopy, MRI and barium swallow. Obes Surg. 1996;6(6):463–7.CrossRefGoogle Scholar
  30. 30.
    Naslund I. A method for measuring the size of the gastric outlet in obesity surgery. Acta Chir Scand. 1984;150(5):399–404.PubMedGoogle Scholar
  31. 31.
    Nishie A, Brown B, Barloon T, et al. Comparison of size of proximal gastric pouch and short-term weight loss following routine upper gastrointestinal contrast study after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17(9):1183–8.CrossRefGoogle Scholar
  32. 32.
    Madan AK, Tichansky DS, Phillips JC. Does pouch size matter? Obes Surg. 2007;17(3):317–20.CrossRefGoogle Scholar
  33. 33.
    Langer FB, Bohdjalian A, Felberbauer FX, et al. Does gastric dilatation limit the success of sleeve gastrectomy as a sole operation for morbid obesity? 2006;2:166–71.Google Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • W. K. Karcz
    • 1
    Email author
  • S. Kuesters
    • 1
  • G. Marjanovic
    • 1
  • D. Sueßlin
    • 2
  • E. Kotter
    • 2
  • O. Thomusch
    • 1
  • U. T. Hopt
    • 1
  • G. Felmerer
    • 3
  • M. Langer
    • 2
  • T. Baumann
    • 2
  1. 1.Department of General and Visceral SurgeryAlbert-Ludwigs-UniversityFreiburgGermany
  2. 2.Department of Diagnostic RadiologyAlbert-Ludwigs-UniversityFreiburgGermany
  3. 3.Department of Plastic and Hand SurgeryAlbert-Ludwigs-UniversityFreiburgGermany

Personalised recommendations