Laparoscopic sleeve gastrectomy: Imaging of normal anatomic features and postoperative gastrointestinal complications

Abstract

Morbid obesity is a public health problem in the United States and Europe and its prevalence is on the increase. Despite certain progress the efficacy of medical treatment remains limited. Bariatric surgery has consequently become an effective alternative for patients with morbid obesity. The bariatric operations most frequently performed are laparoscopic adjustable gastric banding (LAGB) and Roux-en-Y gastric bypass (LGB), but laparoscopic sleeve gastrectomy (LSG) is increasingly popular with both bariatric surgeons and patients due to its simplicity, rapidity and decreased morbidity. The purpose of this pictorial essay is to familiarize radiologists with the normal postoperative anatomic features and the imaging findings of postoperative gastrointestinal complications of laparoscopic sleeve gastrectomy because little literature exists on this subject.

Clinical–radiologic evaluation of the complications of laparoscopic sleeve gastrectomy: Value of multidetector CT

“…In the current study, abscess occurred in 1 case (3.3%) among the study group and was located in the left subphrenic space in agreement with (11,4,12) who reported similar incidence. It was treated by CT-guided percutaneous drainage with suitable antibiotic coverage.…”

“…In this study that included 240 patients, CT was done only for 30 patients with clinically or radiologically suspected complication even in the presence of negative UGI series and it detected complication in 11 patients out of the 30 patients (36.7%), with no mortality in agreement with Chivot et al (11) who stated that the overall published complications rate ranges from 0% to 24%. Clinical-radiologic evaluation of the complications 5…”

“…Splenic infarction was detected by CT in 2 cases (6.7%) and appeared as well defined peripherally based nonenhanced hypodense triangular area of splenic infarction in the upper pole and was discovered 12 days postoperative in agreement with Chivot et al (11) who reported similar incidence. Splenic infarction may be explained by injury or occlusion of peripheral splenic arterial branches when the surgeon exposes the greater curvature and separately coagulates the short gastric vessels close to the spleen.…”

“…Chivot et al (11) explained the incidence of leaks in the 1st 48 h due to mechanical or technical errors while for late onset (within 5-7 days) due to ischemia caused by tension and poor wound healing. And in both scenarios, the intraluminal pressure exceeds the potency of the tissues and staple lines resulting in a leak.…”

“…As the patient swallows, one-per-second rapid sequence images of the stomach are obtained in the frontal projection, then in oblique and lateral projections and finally in the reverse Trendelenburg position. We utilized Chivot et al (11) criteria that report that a completely normal postoperative examination shows a regular sleeve around the nasogastric tube without delayed passage of contrast material and without any additional images. Delayed passage of contrast material is frequently observed during the early postoperative state, most probably due to secondary edema of the pylorus and remaining stomach.…”