Complications of Adjustable Gastric Banding, a Radiological Pictorial Review

Mehanna, Mayssoun J.; Birjawi, Ghina A.; Moukaddam, Hicham; Khoury, Ghattas; Hussein, Maher; Al-Kutoubi, Aghiad

doi:10.2214/ajr.04.0655

Cited by 59 publications

(54 citation statements)

References 12 publications

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“…This can be more formally measured using the phi angle, which is the angle created by intersecting a line drawn parallel to the spinal column with a line drawn parallel to the plane of the gastric band on an anteroposterior projection. Normally this angle should range from 4˚to 58˚ [25]. Stomal stenosis and acute concentric pouch dilatation are the most common complications after LAGB [26], and present with nocturnal reflux, vomiting and upper abdominal discomfort.…”

Section: Normal Post-operative Imaging Appearancementioning

confidence: 99%

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

Shah¹,

Shah²,

Ahmed³

et al. 2011

BJR

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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.

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Section: Normal Post-operative Imaging Appearancementioning

confidence: 99%

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

Shah¹,

Shah²,

Ahmed³

et al. 2011

BJR

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“…The criteria we use for abnormalities have not been validated in studies but reflect anatomic changes associated with placement of the band and in general, are widely reported. Most studies from both the surgical and radiology literature have examined outlet stenosis, esoph- ageal dilation greater than 2× normal, reflux, esophageal atony, and requirement of multiple esophageal peristaltic waves for clearance of contrast, in addition to slips, as indications for removal of fluid [12,[15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Surgeon-performed Fluoroscopy Conducted Simultaneously During all Laparoscopic Adjustable Gastric Band Adjustments Results in Significant Alterations in Clinical Decisions

et al. 2009

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“…2 The two restrictive procedures favored are the Roux-en-Y gastric bypass procedure (RYGBP; Figure 1A) and the laparoscopic adjustable gastric banding procedure (LAGBP; Figure 1B). [2][3][4] Both types usually are performed laparoscopically and have a low morbidity and mortality compared with open procedures. 2 The major advantage of the RYGBP is its effectiveness in the morbidly obese patient with a BMI ≥ 50 kg/m 2 ; the LAGBP is not as effective in this cohort.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…Late strictures are not uncommon, and have been reported in as many as 27% of patients. 3,4 These strictures usually can be managed with endoscopic dilation.…”

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confidence: 99%

Radiologic Evaluation of Patients Following Bariatric Surgery

Thompson

Merkle

2009

Contemporary Diagnostic Radiology

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Overweight: body mass index (BMI) of 25 to 29 kg/m 2 ; • Obese: BMI of 30 to 39 kg/m 2 ; and • Morbidly obese: BMI of ≥ 40 kg/m 2 . The prevalence of obesity in the U.S. population was reported to have increased from 23% to 31% over the 20 years from 1982 to 2001. 1 Obesity is a risk for many acute and chronic health problems. 2 Approximately 280,000 annual deaths in the United States are due to obesity 2 ; thus, weight loss treatment is one of the most rapidly growing treatments in the United States. Numerous reports have shown that surgery is the most effective method for weight reduction. 2 Surgical ProceduresTwo types of bariatric surgical procedures have been developed: malabsorptive and restrictive. 2 Because of significant complications that accompanied the intestinal malabsorptive procedures, they are no longer used. One of the restrictive procedures, biliopancreatic diversion with duodenal switch, is not favored in the United States. 2 The two restrictive procedures favored are the Roux-en-Y gastric bypass procedure (RYGBP; Figure 1A) and the laparoscopic adjustable gastric banding procedure (LAGBP; Figure 1B). 2-4 Both types usually are performed laparoscopically and have a low morbidity and mortality compared with open procedures. 2 The major advantage of the RYGBP is its effectiveness in the morbidly obese patient with a BMI ≥ 50 kg/m 2 ; the LAGBP is not as effective in this cohort. The laparoscopic RYGBP also has been shown to produce more effective long-term weight loss than the LAGBP. 2 The advantages of the LAGBP are that it has a lower complication rate and the possibility remains of conversion to RYGBP at a later date.To perform a laparoscopic RYGBP, the surgeon creates a small (15-30 mL) gastric pouch, which is anastomosed to a retro-or antecolic and ante-or retrogastric Roux limb with either end-to-side or side-to-side anastomosis. Some authors report a lower complication rate with the antecolic, antegastric Roux limb. 3 When a side-to-side anastomosis to the gastric pouch is performed, a short, blind-ending jejunal stump is created; this stump should not be confused with a leak on postoperative gastrointestinal fluoroscopic studies. The enterostomy sites are stapled closed. The surgeon transects the jejunum approximately 30 cm from the ligament of Treitz and brings up to the gastric pouch the Roux limb, which should measure 75 to 150 cm (see Figure 1A). Longer limbs are used for massively obese patients. To avoid internal hernias, it is important for the surgeon to close the mesenteric defects in the jejunum and transverse colon. 3 With placement of the lap band for a LAGBP, the surgeon tries to place the band approximately 2 cm distal to the gastroesophageal junction, which produces a small gastric pouch, limiting food intake. However, due to patient anatomy, the lap band often is placed at the gastroesophageal junction. The access port is placed outside the peritoneal cavity in the subcutaneous fat. The tightness of the lap band is adjusted by varying the All faculty and staff in a positio...

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Complications of Adjustable Gastric Banding, a Radiological Pictorial Review

Cited by 59 publications

References 12 publications

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

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

Surgeon-performed Fluoroscopy Conducted Simultaneously During all Laparoscopic Adjustable Gastric Band Adjustments Results in Significant Alterations in Clinical Decisions

Radiologic Evaluation of Patients Following Bariatric Surgery

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