3dct Conduit and Oesophageal Metrics, a Valuable Method to Diagnose Post Sleeve Gastrectomy Abnormalities

Abstract

Purpose Reflux after laparoscopic sleeve gastrectomy (LSG) may result from anatomical and functional anomalies in the gastric conduit. Three-dimensional CT scans (3DCT) offer a comprehensive view of gastric anatomy. This study aims to establish specific measurements associated with sleeve abnormalities to standardise the reporting of 3DCT which may help in management of LSG complications. Materials and Methods This retrospective study analysed 64 post-LSG patients who underwent gastric 3DCT. Data included clinical demographics, pre-LSG BMI, BMI at 3DCT, and the duration between surgery and examination. Symptomatology prompts the scan and other concurrent investigations. Various 3DCT measurements were taken, including angularis angle (AA), surface area (ASA), conduit length (CL), proximal maximal surface area (PMSA), and distal maximal surface area (DMSA) of the gastric conduit. Patients were categorised based on endoscopy findings and symptomatology. Outcomes post-revisional surgery were assessed and analysed. Results 20.3% were male. Pre-LSG BMI and BMI at 3DCT were 45.57 (± 8.3) and 36.3 (± 8.7), respectively. Mean surgery-to-scan period was 6.2 years. 71.8% of patients presented with reflux, regurgitation, or dysphagia, whilst the remainder primarily exhibited weight regain. Patients with endoscopic evidence of stenosis/reflux demonstrated significantly lower gastric volume, ASA, and DMSA (p = 0.002 and p = 0.007, respectively). Oesophageal diameter above the conduit and an ASA to DMSA ratio ≤ 0.5 were negatively associated with AA (p = 0.008 and p = 0.08, respectively). Patients with improved outcomes after revisional bypass and gastrogastrostomy displayed a negative correlation with ASA and positive correlation with the ASA to PMSA ratio (≤ 0.5). Conclusion 3DCT measurements have a potential role in defining post-LSG stenosis and predicting outcomes of revisional surgery. Patients with anatomic abnormalities that are shown on CT appear to improve with anatomic correction. Graphical Abstract