Imaging in bariatric surgery: service set-up, post-operative anatomy and complications

Abstract

ABSTRACT. Obesity is an increasingly prevalent and costly problem faced by the healthcare system. The role of bariatric surgery in managing obesity has also increased with evidence showing a reduction in long-term morbidity and mortality. There are unique challenges faced by the radiology department in providing an imaging service for this population of patients, from technical and staffing requirements through to the interpretation of challenging post-surgical images. We describe these challenges and provide an overview of the most frequently performed procedures, normal postoperative imaging findings and the appearance of common complications. ObesityObesity is a multifactorial disease, which is increasing in incidence and prevalence. In 2006, 67% of men and 56% of women were classified as being either overweight or obese in England [1]. Overall, 24% of adults were classified as obese, an increase from 15% in 1993, and 16% of children aged 2-15 years were classified as obese, an increase from 11% in 1995. Estimates suggest that at the current rate of increase, by 2010 there will be 12 million adults and 1 million children categorised as obese. The body mass index (BMI, kg m -2 ) is the most widely used measure of obesity; BMI between 25 and 30 signifies being overweight and BMI greater than 30 signifies obesity. BMI greater than 35 with obesityrelated serious comorbidities or greater than 40 with or without comorbidities is defined as morbid obesity.

Patient obesity and the practical experience of the plain radiography professional: On everyday ethics, patient positioning and infelicitous equipment

“…In technical terms, and in line with observations in extant literature [5,15] , the equipment concerns that dominated participants' experiences were The core technical problems in imaging obese patients recognised by Carucci [3] are highly evident herein, though framed within a context of limited time and resources. A shortfall in the efficacy of the available technology for a particular purpose, in short, mandates (perhaps undesirably) quick clinical decision-making regarding how to make 'the best of a bad situation'.…”

“…Within Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), table weight limits and gantry sizes are reported to be significant obstacles to the effective imaging morbidly obese patients [5,6,15,22] . This can sometimes mandate that clinicians who are unaware of a patient's weight in advance make an ad-hoc switch to other diagnostic imaging modalities [14] , rather than risk damage to expensive equipment [15] .…”

“…Furthermore, table width is typically determined by normative shoulder-to-shoulder measurements. With obese patients, however, the abdominal area is often the widest point of the body, rendering some imaging tables simply unfit for purpose [5] in these circumstances. Such problems arising during an examination can have a highly undesirable psychosocial impact on the patient [6] .…”

“…In terms of issues surrounding physical apparatus in radiography [5,6,15] , an array of problems was identified by participants, with a variety of consequences. One of the most striking of these -bridging the issues of patient handling and equipment -pertained to the simple examination gowns with which patients are provided:…”

“…In the UK by 2013, one quarter of all adults were classed as clinically obese [4] . This upward trend is widely thought to be a major contributory factor in the increasing workloads of medical imaging professionals [5] .…”