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Three-dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration

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Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is frequently performed as a definitive bariatric procedure today. Quantitative data on the detailed anatomy of the stomach after LSG are yet sparse.

Methods

Thirty-two multislice computed tomography (MSCT) data sets acquired in 27 LSG patients (22 female, 5 male) with a dedicated examination protocol and post-processing were evaluated for gastric volume, stomach length, sleeve length, antrum length, staple line length, and maximum cross-sectional sleeve area. Obtained parameters were compared to time after surgery, weight loss, and the occurrence of postsurgical regurgitation.

Results

Mean gastric volume was 186.5 ± 88.4 ml. Gastric volume correlated significantly with the time interval after surgery. Sleeve sizes of 105.3 ± 30.2 ml during early follow-up confirmed correct primary sizing of the sleeve, whereas marked dilation to 196.8 ± 84.3 ml was found in patients with a follow-up of 6 months and longer (p = 0.038). Sleeve area and staple line length were also positively correlated with time after surgery. No correlation was found between gastric volume and excess weight loss. In ten patients an intrathoracic migration of the staple line could be noted, with four of these patients developing persistent regurgitation after LSG. Regurgitation was present in only 2 of 17 patients without sleeve herniation.

Conclusion

Multislice computed tomography allows for a comprehensive and quantitative evaluation of the anatomy after LSG and thus provides new insights in the process of sleeve dilation. Intrathoracic migration of the staple line could be identified as a possible cause of persistent regurgitation.

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Disclosures

T. Baumann, J. Grueneberger, G. Pache, S. Kuesters, G. Marjanovic, B. Kulemann, P. Holzner, I. Karcz-Socha, D. Suesslin, U. T. Hopt, M. Langer, and W. Karcz have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, University Hospital Freiburg, Albert-Ludwigs-University, Hugstetter Straße 55, 79106, Freiburg, Germany

    Tobias Baumann, Gregor Pache, Dorothea Suesslin & Mathias Langer

  2. Department of General and Visceral Surgery, University Hospital Freiburg, Albert-Ludwigs-University, Freiburg, Germany

    Jodok Grueneberger, Simon Kuesters, Goran Marjanovic, Birte Kulemann, Philipp Holzner, Ulrich T. Hopt & Wojciech K. Karcz

  3. Internal Medicine Clinic, Policlinic Hospital, Opole, Poland

    Iwona Karcz-Socha

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  1. Tobias Baumann
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  2. Jodok Grueneberger
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  3. Gregor Pache
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  4. Simon Kuesters
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  9. Dorothea Suesslin
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  10. Ulrich T. Hopt
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  11. Mathias Langer
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  12. Wojciech K. Karcz
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Corresponding author

Correspondence to Tobias Baumann.

Additional information

T. Baumann and J. Grueneberger contributed equally to this work.

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Baumann, T., Grueneberger, J., Pache, G. et al. Three-dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration. Surg Endosc 25, 2323–2329 (2011). https://doi.org/10.1007/s00464-010-1558-0

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  • DOI: https://doi.org/10.1007/s00464-010-1558-0

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