Abstract
The prevalence of obesity is increasing, along with the number of bariatric surgical procedures performed to treat obesity. Laparoscopic sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and laparoscopic gastric banding (GB) comprise the vast majority of procedures with SG now the dominant procedure in the USA. Although multidetector computed tomography (MDCT) is not always the examination of choice for a particular suspected complication, many of these patients present with non-specific abdominal symptoms and undergo MDCT evaluation as an initial diagnostic test. This pictorial essay will review and discuss the normal post-surgical bariatric appearance on MDCT, and the appearance of common and uncommon complications associated with the common bariatric procedures on MDCT with correlative imaging. SG complications include leak/abscess, hemorrhage, splenic injury, and portomesenteric thrombosis. RYGB complications include leak/abscess, gastrogastric fistula, small bowel obstruction, internal hernia, and intussusception. Although GB is waning in popularity, radiologists continue to see the legacy of these patients and complications include gastric prolapse, band erosion, and port/tubing mechanical failures. Awareness of the characteristic findings of bariatric complications on MDCT is critical, allowing for earlier recognition and prompt intervention.
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References
Cawley J, Meyerhoefer C (2012) The medical care costs of obesity: an instrumental variables approach. J Health Econ 31:219–230. doi:10.1016/j.jhealeco.2011.10.003
American Society for Metabolic and Bariatric Surgery (2014) Estimate of bariatric surgery numbers. ASMBS. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Accessed 30 Jan 2015
Levenson RB, Camacho MA, Horn E et al (2012) Eliminating routine oral contrast use for CT in the emergency department: impact on patient throughput and diagnosis. Emerg Radiol 19:513–517. doi:10.1007/s10140-012-1059-7
Lee SY, Coughlin B, Wolfe JM et al (2006) Prospective comparison of helical CT of the abdomen and pelvis without and with oral contrast in assessing acute abdominal pain in adult emergency department patients. Emerg Radiol 12:150–157
Naeger DM, Chang SD, Kolli P et al (2011) Neutral vs positive oral contrast in diagnosing acute appendicitis with contrast-enhanced CT: sensitivity, specificity, reader confidence and interpretation time. BJR 84:418–426. doi:10.1259/bjr/20854868
Triantafyllidis G, Lazoura O, Sioka E et al (2011) Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg 21(4):473–478. doi:10.1007/s11695-010-0339-0
Chivot C, Robert B, Lafaye N et al (2013) Laparoscopic sleeve gastrectomy: imaging of normal anatomic features and postoperative gastrointestinal complications. Diagn Interv Imaging 94:823–834. doi:10.1016/j.diii.2013.03.017
Swartz DE, Felix EL (2004) Acute mesenteric venous thrombosis following laparoscopic Roux-en-Y gastric bypass. JSLS 8:165–169
Csendes A, Braghetto I, León P, Burgos AM (2010) Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity. J Gastrointest Surg 14(9):1343–1348. doi:10.1007/s11605-010-1249-0
Lee CM, Cirangle PT, Jossart GH (2007) Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc 21(10):1810–1816. doi:10.1007/s00464-007-9276-y
Aurora AR, Khaitan L (2012) Sleeve gastrectomy and the risk of leak: a systematic analysis of 4888 patients. Surg Endosc 26:1509–1515. doi:10.1007/s00464-011-2085-3
Madan AK, Stoechklein HH, Ternovits CA et al (2007) Predictive value of upper gastrointestinal studies versus clinical signs for gastrointestinal leaks after laparoscopic gastric bypass. Surg Endosc 21(2):194–196. doi:10.1007/s00464-005-0700-x
Puli SR, Spofford IS, Thompson CC (2012) Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc 75(2):287–293. doi:10.1016/j.gie.2011.09.010
Fuks D, Verhaeghe P, Brehant O et al (2009) Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery 145:106–113. doi:10.1016/j.surg.2008.07.013
Ganger M, Deitel M (2009) The second international consensus summit for sleeve gastrectomy. Surg Obes Relat Dis 5:476–485. doi:10.1016/j.soard.2009.06.001
Gibson SC, Le Page PA, Taylor CJ (2015) Laparoscopic sleeve gastrectomy: review of 500 cases in single surgeon Australian practice. ANZ J Surg 85(9):673–677. doi:10.1111/ans.12483
Singh P, Sharma M, Gandhi K et al (2010) Acute mesenteric vein thrombosis after laparoscopic gastric sleeve surgery for morbid obesity. Surg Obes Relat Dis 6:107–108. doi:10.1016/j.soard.2009.08.003
Takagi S (1998) Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum for laparoscopic hepatectomy. Surg Endosc 12:427–431
Jakimowicz J, Stultiens G, Smulder F (1998) Laparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc 12:129–132
Grundy SM (2004) Obesity, metabolic syndrome, and cardiovascular disease. J Clin Endocrinol Metab 89(6):2595–2600
Vandenbroucke JP, Rosing J, Bloemenkamp KW et al (2001) Oral contraceptives and the risk of venous thrombosis. N Engl J Med 344(20):1527–1535
Anderson JA, Weitz JI (2011) Hypercoagulable states. Crit Care Clin 27(4):933–952. doi:10.1016/j.ccc.2011.09.007
Herron D, Roohipour R (2012) Complications of Roux-en-Y gastric bypass and sleeve gastrectomy. Abdom Imaging 37:712–718. doi:10.1007/s00261-012-9866-6
Chandler RC, Srinivas G et al (2008) Imaging in bariatric surgery: a guide to postsurgical anatomy and common complications. Am J Roentgenol 190:122–135. doi:10.2214/AJR.07.2134
Shah S, Shah V, Ahmed AR et al (2011) Imaging of bariatric surgery: service set-up, postoperative anatomy and complications. Br J Radiol 84:101–111. doi:10.1259/bjr/18405029
Singh R, Fisher BL (2003) Sensitivity and specificity of postoperative upper GI series following gastric bypass. Obes Surg 13(1):73–75
Jones KB Jr, Afram JD, Benotti PN et al (2006) Open versus laparoscopic Roux-en-Y gastric bypass: a comparative study of over 25,000 open cases and the major laparoscopic bariatric reported series. Obes Surg 16(6):721–727
Tucker ON, Escalante-Tattersfield T et al (2007) The ABC system: a simplified classification system for small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Obes Surg 17(12):1549–1554. doi:10.1007/s11695-007-9273-1
Lockhart ME, Tessler FN et al (2007) Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. Am J Roentgenol 188(3):745–750
Ximenes MA, Baroni RH, Trindade RM et al (2011) Petersen’s hernia as a complication of bariatric surgery: CT findings. Abdom Imaging 36(2):126–129. doi:10.1007/s00261-010-9626-4
Champion JK, Williams M (2003) Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg 13(4):596–600
Daellenbach L, Suter M (2011) Jejunojejunal intussusception after Roux-en-Y gastric bypass: a review. Obes Surg 21:253–263. doi:10.1007/s11695-010-0298-5
Shaw D, Huddleston S, Beilman G (2010) Anterograde intussusception following laparoscopic Roux-en-Y gastric bypass: a case report and review of the literature. Obes Surg 20:1191–1194. doi:10.1007/s11695-009-0037-y
Stephenson D, Moon RC, Teixeria AF, Jawad MA (2014) Intussusception after Roux-en-Y gastric bypass. Surg Obes Relat Dis 10(4):666–670. doi:10.1016/j.soard.2014.01.026
Sonavane SK, Menias CO, Kantawala KP et al (2012) Laparoscopic adjustable gastric banding: what radiologists need to know. Radiographics 32:1161–1178. doi:10.1148/rg.324115177
Gaetke-Udager K, Wasnik AP, Kaza RK et al (2014) A guide to imaging in bariatric surgery. Emerg Radiol 21:309–319. doi:10.1007/s10140-013-1171-3
Carucci LR, Turner MA, Szucs RA (2007) Adjustable laparoscopic gastric banding for morbid obesity: imaging assessment and complications. Radiol Clin N Am 45:261–274. doi:10.1016/j.rcl.2007.03.003
Prosch H, Tscherney R, Kriwanek S, Tscholakoff D (2008) Radiographical imaging of the normal anatomy and complications after gastric banding. Br J Radiol 81:753–757. doi:10.1259/bjr/95353541
Levine MS, Carucci LR (2014) Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology 270(2):327–341. doi:10.1148/radiol.13122520
Varghese JC, Roy-Choudhury SH (2009) Radiological imaging of the GI tract after bariatric surgery. Gastrointest Endosc 70(6):1176–1181. doi:10.1016/j.gie.2009.06.025
Acknowledgments
We would like to thank John Bonnett, MD for the original schematic illustrations of the different types of bariatric surgery.
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Riaz, R.M., Myers, D.T. & Williams, T.R. Multidetector CT imaging of bariatric surgical complications: a pictorial review. Abdom Radiol 41, 174–188 (2016). https://doi.org/10.1007/s00261-015-0604-8
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DOI: https://doi.org/10.1007/s00261-015-0604-8