Computed tomography as primary postoperative follow-up after laparoscopic Roux-en-Y gastric bypass

Abstract

AIMTo evaluate upper abdominal computed tomography (CT) scan as primary follow-up after laparoscopic Roux-en-Y gastric bypass (LRYGB).METHODSThis prospective study was approved by the Ethical Committee of the State of Zurich, and informed consent was obtained from all patients. Sixty-one patients who underwent LRYGB received upper abdominal CT on postoperative day 1, with the following scan parameters: 0.6 mm collimation, 1.2 mm pitch, CareKV with reference 120 mAs and 120 kV, and 0.5 s rotation time. Diluted water-soluble radiographic contrast-medium (50 mL) was administered to achieve gastric pouch distension without movement of the patient. 3D images were evaluated to assess postoperative complications and the radiation dose received was analysed.RESULTSFrom the 70 patients initially enrolled in the study, 9 were excluded from analysis upon the intraoperative decision to perform a sleeve gastrectomy and not a LRYGB. In all of the 61 patients who were included in the analysis, CT was feasible and there were no instances of aspiration or vomiting. In 7 patients, two upper abdominal scans were necessary as the pouch was not distended by contrast medium in the first acquisition. Radiologically, no leak and no relevant stenosis were found on the first postoperative day. These early postoperative CT findings were consistent with the findings at clinical follow-up 6 wk postoperatively, with no leaks, stenosis or obstructions being diagnosed. The average total dose length product in CT was 536.6 mGycm resulting in an average effective dose of 7.8 mSv. The most common surgical complication, superficial surgical site infections (n = 4), always occurred at the upper left trocar site, where the circular stapler had been introduced.CONCLUSIONEarly LRYGB postoperative multislice spiral CT scan is feasible, with low morbidity, and provides more accurate anatomical information than standard upper gastrointestinal contrast study.

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

“…A selective strategy of postoperative UGI series use was found to be noninferior to a liberal strategy in terms of postoperative outcomes 176. Some authors recommend a selective postoperative use of CT scan because of its superior sensitivity 173,175…”

“…170 In a head to head comparison, CT with oral contrast is superior to UGI series with a sensitivity of 95% versus 79.4%, respectively. 169 Therefore, CT is considered as the best noninvasive test for detection and confirmation of leak 9,56,125,143,162,165,[171][172][173] and should be triggered by clinical suspicion. 173,174 However, UGI series remains important in evaluating the location and size of leaks even after a leak is identified by cross-sectional imaging.…”

“…169 Therefore, CT is considered as the best noninvasive test for detection and confirmation of leak 9,56,125,143,162,165,[171][172][173] and should be triggered by clinical suspicion. 173,174 However, UGI series remains important in evaluating the location and size of leaks even after a leak is identified by cross-sectional imaging. 164 There is a lack of consensus regarding postoperative use of imaging for screening and early detection of leaks.…”

Excess visceral fat area as an independent risk factor for early postoperative complications in patients with obesity undergoing bariatric surgery

“…Although there is no consensus regarding routine CT-scanning before bariatric surgery, it can be used to guide the surgeon to determine the type of bariatric surgery to be offered to the patient and to evaluate the volumetric assessment of stomach and gastric sleeves in patients before and after bariatric surgery ( 27 , 28 ). The concern associated with the use of CT is its radiation dose; however, it has been shown that, using the proper protocol, the average individual effective dose in bariatric patients is 7.8 mSv, which is not considerably higher than that used in an upper gastrointestinal study ( 29 ).…”

Imaging after laparoscopic sleeve gastrectomy – literature review with practical recommendations

“…In recent years, CT has been increasingly used as a primary postoperative examination after bariatric procedures for complication detection. The main concern associated with the use of CT is its high radiation dose; however, it has been shown that with a proper protocol an average effective dose of 7.8 mSv is achievable in bariatric patients, which is not much higher than for a UGI study (approximately 6 mSv according to the American College of Radiology) [ 26 ].…”