Obesity Surgery

, Volume 28, Issue 9, pp 2923–2931 | Cite as

Imaging after Bariatric Surgery: When Interpretation Is a Challenge, from Normal to Abnormal

  • Evelyn Astrid Dorado AlbanEmail author
  • Carlos A. García
  • Laura M. Ospina
  • Hernán E. Munevar
Review Article


Bariatric surgery has proven to be the most effective weight loss strategy in severe obesity. Imaging in the immediate postoperative period of bariatric surgery is not done routinely. However, it is helpful in the assessment of early and late complications, which are estimated to be present in < 1% of patients. In some cases, the imaging interpretation of anatomical outcomes and complications related to these procedures represents a challenge for surgeons and radiologists. The aim of this review is to describe the imagenologic findings after bariatric surgery and focuses on the findings of the most frequent procedures performed in Colombia such as laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and laparoscopic adjustable gastric banding. Contrasted CT scan and fluoroscopic studies have shown a high sensitivity in the early and late diagnosis of bariatric surgery complications, but in order to be able to appropriately identify these complications, it is important to be familiar with the normal or expected radiological findings.


Sleeve gastrectomy Gastric bypass Stenosis Fistula 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Yaghoubian A, Tolan A, Stabile BE, et al. Laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy achieve comparable weight loss at 1 year. Am Surg. 2012;78(12):1325–8. Available from: Google Scholar
  2. 2.
    Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg. 2003;13(3):329–30. Available from: Google Scholar
  3. 3.
    Monteforte MJ, Turkelson CM. Bariatric surgery for morbid obesity. Obes Surg. 2000;10(5):391–401. Available from: Google Scholar
  4. 4.
    Mónica Arango Arango. Entidades regionales se unen contra la obesidad. El Tiempo. 2015. Available from:
  5. 5.
    Goitein D, Goitein O, Feigin A, et al. Sleeve gastrectomy: radiologic patterns after surgery. Surg Endosc. 2009;23(7):1559–63. Available from: Google Scholar
  6. 6.
    Goitein D, Papasavas PK, Gagn DJ, et al. Late perforation of the jejuno-jejunal anastomosis after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2005;15(6):880–2. Available from: Google Scholar
  7. 7.
    Levine MS, Carucci LR. Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology. 2014;270(2):327–41. Available from: Google Scholar
  8. 8.
    Ni Mhuircheartaigh J, Abedin S, Bennett AE, et al. Imaging features of bariatric surgery and its complications. Semin Ultrasound CT MRI. 2017;34(4):311–24. Available from: Scholar
  9. 9.
    Chandler RC, Srinivas G, Chintapalli KN, et al. Imaging in bariatric surgery: a guide to postsurgical anatomy and common complications. Am J Roentgenol. 2008;190(1):122–35. Available from: Google Scholar
  10. 10.
    Esteban Varela J, Nguyen NT. Laparoscopic sleeve gastrectomy leads the U.S. utilization of bariatric surgery at academic medical centers. Surg Obes Relat Dis. 2015;11(5):987–90. Available from: Google Scholar
  11. 11.
    Carucci LR, Turner MA, Nehoda H, et al. Imaging after bariatric surgery for morbid obesity: Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding. Semin Roentgenol. 2009;44(4):283–96. Available from: Google Scholar
  12. 12.
    Gagnon LE, Karwacki Sheff EJ. Outcomes and complications after bariatric surgery. AJN, Am J Nurs. 2012;112(9):26–36. Available from: Google Scholar
  13. 13.
    Quigley S, Colledge J, Mukherjee S, et al. Bariatric surgery: a review of normal postoperative anatomy and complications. Clin Radiol. 2011;66(10):903–14. Available from: Google Scholar
  14. 14.
    Dorado E, Bernal J. Tecnicas basicas y Avanzadas en Laparoscopia 2014. 174–153 p.Google Scholar
  15. 15.
    Brockmeyer JR, Simon TE, Jacob RK, et al. Upper gastrointestinal swallow study following bariatric surgery: institutional review and review of the literature. Obes Surg. 2012;22(7):1039–43. Available from: Google Scholar
  16. 16.
    Xu T, Rosculet N, Steele K, et al. Comparison of upper gastrointestinal fluoroscopy versus computed tomography for evaluation of post-operative leak in a bariatric surgery patient. BJR Case Rep. 2017;3(1):20160076. Available from: Google Scholar
  17. 17.
    Fernandez Jr AZ, EJ DM, Tichansky DS, et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc. 2004;18(2):193–7. Available from: Google Scholar
  18. 18.
    Nguyen NT, Wilson SE. Complications of antiobesity surgery. Nat Clin Pract Gastroenterol Hepatol. 2007;4(3):138–47. Available from: Google Scholar
  19. 19.
    Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass. Arch Surg. 2003;138(9):957. Available from:–61.Google Scholar
  20. 20.
    Ni Mhuircheartaigh J, Abedin S, Bennett AE, et al. Imaging features of bariatric surgery and its complications. Semin Ultrasound CT MRI. 2013;34(4):311–24. Available from: Google Scholar
  21. 21.
    Pauli EM, Beshir H, Mathew A. Gastrogastric fistulae following gastric bypass surgery-clinical recognition and treatment. Curr Gastroenterol Rep. 2014;16(9):405.Google Scholar
  22. 22.
    Werquin C, Caudron J, Mezghani J, et al. Early imaging features after sleeve gastrectomy. J Radiol. 2008;89(11 Pt 1):1721–8. Available from: Google Scholar
  23. 23.
    Triantafyllidis G, Lazoura O, Sioka E, et al. Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2011;21(4):473–8. Available from: Google Scholar
  24. 24.
    Evans JA, Muthusamy VR, Acosta RD, et al. The role of endoscopy in the bariatric surgery patient. Gastrointest Endosc. 2015;81(5):1063–72.Google Scholar
  25. 25.
    Carrodeguas L, Szomstein S, Zundel N, et al. Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1291 patients. Surg Obes Relat Dis. 2006;2(2):92–7.Google Scholar
  26. 26.
    Carucci LR, Turner MA, Conklin RC, et al. Roux-en-Y gastric bypass surgery for morbid obesity: evaluation of postoperative extraluminal leaks with upper gastrointestinal series. Radiology. 2006;238(1):119–27. Available from: Google Scholar
  27. 27.
    Hamdan K, Somers S, Chand M. Management of late postoperative complications of bariatric surgery. Br J Surg. 2011;98(10):1345–55. Available from: Google Scholar
  28. 28.
    Nguyen NT, Stevens CM, Wolfe BM. Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. J Gastrointest Surg. 2003;7(8):997–1003. discussion 1003. Available from: Google Scholar
  29. 29.
    Yimcharoen P, Heneghan HM, Singh M, et al. Endoscopic findings and outcomes of revisional procedures for patients with weight recidivism after gastric bypass. Surg Endosc. 2011;25(10):3345–52. Available from: Google Scholar
  30. 30.
    Montravers P, Augustin P, Zappella N, et al. Diagnosis and management of the postoperative surgical and medical complications of bariatric surgery. Anaesth Crit Care Pain Med. 2015;34(1):45–52. Available from: Google Scholar
  31. 31.
    Blachar A, Federle MP, Pealer KM, et al. Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology. 2002;223(3):625–32. Available from: Google Scholar
  32. 32.
    Nguyen NT, Huerta S, Gelfand D, et al. Bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2004;14(2):190–6. Available from: Google Scholar
  33. 33.
    Carucci LR. Imaging obese patients: problems and solutions. Abdom Imaging. 2013;38(4):630–46. Available from: Google Scholar
  34. 34.
    Blachar A, Blank A, Gavert N, et al. Laparoscopic adjustable gastric banding surgery for morbid obesity: imaging of normal anatomic features and postoperative gastrointestinal complications. Am J Roentgenol. 2007;188(2):472–9. Available from: Google Scholar
  35. 35.
    Carucci LR, Turner MA, Szucs RA. Adjustable laparoscopic gastric banding for morbid obesity: imaging assessment and complications. Radiol Clin North Am. 2007;45(2):261–74. Available from: Google Scholar
  36. 36.
    Hainaux B, Coppens E, Sattari A, et al. Laparoscopic adjustable silicone gastric banding: radiological appearances of a new surgical treatment for morbid obesity. Abdom Imaging. 1999;24(6):533–7. Available from: Scholar
  37. 37.
    Gumbs A, Duffy A, Chandwani R, et al. Jejunojejunal anastomotic obstruction following laparoscopic Roux-en-Y gastric bypass due to non-absorbable suture: a report of seven cases. Obes Surg. 2006;16(1):12–5. Available from: Google Scholar
  38. 38.
    Carucci LR, Turner MA, Yu J. Imaging evaluation following Roux-en-Y gastric bypass surgery for morbid obesity. Radiol Clin North Am. 2007;45(2):247–60. Available from: Google Scholar
  39. 39.
    Chowbey P, Baijal M, Kantharia NS, et al. Mesenteric defect closure decreases the incidence of internal hernias following laparoscopic Roux-en-Y gastric bypass: a retrospective cohort study. Obes Surg. 2016;26(9):2029–34.Google Scholar
  40. 40.
    Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003 Jun;13(3):350–4.Google Scholar
  41. 41.
    Carucci LR, Conklin RC, Turner MA. Roux-en-Y gastric bypass surgery for morbid obesity: evaluation of leak into excluded stomach with upper gastrointestinal examination. Radiology. 2008;248(2):504–10. Available from: Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Evelyn Astrid Dorado Alban
    • 1
    Email author
  • Carlos A. García
    • 2
  • Laura M. Ospina
    • 2
  • Hernán E. Munevar
    • 3
  1. 1.Department of Minimally Invasive Surgery and Bariatric Surgery, Fundación Valle del LiliUniversidad ICESICaliColombia
  2. 2.Department of RadiologyFundación Valle del LiliCaliColombia
  3. 3.Clinical Research CenterFundación Valle del LiliCaliColombia

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