Imaging of Bariatric Surgery: Normal Anatomy and Postoperative Complications

Abstract

Obesity is a disease that has reached epidemic proportions in the United States and around the world. During the past 2 decades, bariatric surgery has become an increasingly popular form of treatment for morbid obesity. The most common bariatric procedures performed include laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy. Fluoroscopic upper gastrointestinal examinations and abdominal computed tomography (CT) are the major imaging tests used to evaluate patients after these various forms of bariatric surgery. The purpose of this article is to present the surgical anatomy and normal imaging findings and postoperative complications for these bariatric procedures at fluoroscopic examinations and CT. Complications after Roux-en-Y gastric bypass include anastomotic leaks and strictures, marginal ulcers, jejunal ischemia, small bowel obstruction, internal hernias, intussusception, and recurrent weight gain. Complications after laparoscopic adjustable gastric banding include stomal stenosis, malpositioned bands, pouch dilation, band slippage, perforation, gastric volvulus, intraluminal band erosion, and port- and band-related problems. Finally, complications after sleeve gastrectomy include postoperative leaks and strictures, gastric dilation, and gastroesophageal reflux. The imaging features of these various complications of bariatric surgery are discussed and illustrated.

Validation of a new method for the endoscopic measurement of post-bariatric gastric outlet using a standard guidewire: an observer agreement study

“…Most studies will recommend a 20 mm diameter, although diameters as small as 12 mm have been proposed [11]. Despite this growing body of evidence regarding the importance of the anastomosis diameter, the literature can be challenged if the measurement process has not been properly validated.…”

ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management

“…Sensitivity of upper GI contrast examination varies among reports between 22 to 75% [2,37,41]. CT of the abdomen after GB can detect leaks, abscesses, and bowel obstruction and may be better able to discern suspected leaks of the jejunojejunostomy and or remnant stomach [42]. CT may also be better able to discern whether a leak appears "contained" versus "freely" communicating within the abdominal cavity [15].…”

Relationship between gastric pouch and weight loss after laparoscopic sleeve gastrectomy

“…The most relevant early surgical complications are leaks, bleeding and stenosis [23], while the most controversial long-term issues are related with gastroesophageal reflux disease (GERD) [24] and dilation of the gastric tubule. The major aim of this operation is the reduction in the gastric capacity, the final shape resulting in one of these three patterns according to Werquin's classification: real tubular, partial fundus persistence variant and partial antrum persistence variant [25,26].…”