Abstract
Background
Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as an additional bariatric procedure, either as a first step for biliopancreatic diversion or gastric bypass or as a stand-alone option for selected patients. Early postoperative fluid tolerance varies between patients and influences the length of hospital stay. Swallow studies after LSG are not uniform and display different patterns with regard to contrast passage through the gastric sleeve.
Methods
The 55 patients (40 women) in this study underwent LSG during 18 months. These patients had a mean age of 38.2 years (range: 17–61 years) and a mean body mass index (BMI) of 44.8 kg/m2 (range: 39–75 kg/m2). The LSG procedure was performed using a four-port technique to resect the greater curvature of the stomach around a bougie. The mean operative time was 120 min (range: 45–240 min). A routine swallow study was performed on postoperative day 1, and clear fluids were initiated if no leak was detected. Patients were discharged when they could tolerate a daily fluid intake of 2 l.
Results
No mortalities, obstructions, or leaks occurred in the study cohort. Two main patterns of contrast passage were identified: type 1 (immediate unhindered flow through the sleeve to the antrum with a slight delay before continuation of the contrast to the duodenum) and type 2 (contrast filling of the proximal sleeve with delay of flow distally toward the duodenum). Patients with rapid contrast passage (group 1, n = 24) tolerated clear fluids better than those with delayed flow (group 2, n = 31) and were discharged earlier than their counterparts (mean length of hospital stay, 2.5 vs. 3.4 days; p < 0.001).
Conclusions
Tolerance of fluid intake after LSG is crucial for patient recovery and discharge. A distinct radiologic appearance on postoperative day 1 helps to predict this behavior. The different patterns could be related to gastric sleeve construction or to possible postoperative sleeve spasm, hindering fluid passage. The influence of immediate fluid tolerance on weight loss after LSG is currently under investigation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Baltasar A, Serra C, Perez N, Bou R, Bengochea M, Ferri L (2005) Laparoscopic sleeve gastrectomy: a multipurpose bariatric operation. Obes Surg 15:1124–1128
Bertucci W, White S, Yadegar J, Patel K, Han SH, Blocker O, Frickel D, Kadell B, Mehran A, Gracia C, Dutson E (2006) Routine postoperative upper gastroesophageal imaging is unnecessary after laparoscopic Roux-en-Y gastric bypass. Am Surg 72:862–864
Cottam D, Qureshi FG, Mattar SG, Sharma S, Holover S, Bonanomi G, Ramanathan R, Schauer P (2006) Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc 20:859–863
Dallal RM, Bailey L, Nahmias N (2007) Back to basics: clinical diagnosis in bariatric surgery: routine drains and upper gi series are unnecessary. Surg Endosc 21:2268–2271
Doraiswamy A, Rasmussen JJ, Pierce J, Fuller W, Ali MR (2007) The utility of routine postoperative upper GI series following laparoscopic gastric bypass. Surg Endosc 21:2159–2162
Kolakowski S Jr, Kirkland ML, Schuricht AL (2007) Routine postoperative upper gastrointestinal series after Roux-en-Y gastric bypass: determination of whether it is necessary. Arch Surg 142:930–934, discussion 934
Langer FB, Reza Hoda MA, Bohdjalian A, Felberbauer FX, Zacherl J, Wenzl E, Schindler K, Luger A, Ludvik B, Prager G (2005) Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg 15:1024–1029
Lee CM, Cirangle PT, Jossart GH (2007) Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc 21:1810–1816
Melissas J, Koukouraki S, Askoxylakis J, Stathaki M, Daskalakis M, Perisinakis K, Karkavitsas N (2007) Sleeve gastrectomy: a restrictive procedure? Obes Surg 17:57–62
Mognol P, Chosidow D, Marmuse JP (2005) Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg 15:1030–1033
NIH Conference Consensus Development Panel (1991) Gastrointestinal surgery for severe obesity. Ann Intern Med 115:956–961
Regan JP, Inabnet WB, Gagner M, Pomp A (2003) Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 13:861–864
Roa PE, Kaidar-Person O, Pinto D, Cho M, Szomstein S, Rosenthal RJ (2006) Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg 16:1323–1326
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Goitein, D., Goitein, O., Feigin, A. et al. Sleeve gastrectomy: radiologic patterns after surgery. Surg Endosc 23, 1559–1563 (2009). https://doi.org/10.1007/s00464-009-0337-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-009-0337-2