Gastric restrictive surgery for obesity: early radiologic evaluation.

Abstract

This study was undertaken to determine the optimal radiologic examination techniques for the period immediately following gastric restrictive surgery to control obesity. Review of 450 examinations performed on 275 patients who underwent varied gastric restrictive procedures indicates that accurate evaluation requires prompt filming of the first swallow of contrast material in a specific initial patient position with only minimal fluoroscopic monitoring. It was found that the optimal patient position can be predicted, before contrast material is administered, by the orientation of the staples on an abdominal radiograph. Right posterior oblique (RPO) is the optimal starting position when vertical staple lines follow gastroplasty with a lesser curvature channel. Left posterior oblique (LPO) is optimal when horizontal staple lines follow gastroplasty. LPO is usually optimal when complex or confusing staple patterns follow gastric bypass operations and revisions of previous procedures to control obesity. However, RPO is the optimal orientation when the revision procedure is a vertical gastroplasty.

Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity

“…Small perforations that might otherwise have healed may therefore be stressed with early feeding. Finally, contrast studies are difficult to interpret given the physical limitations of the patients and the complex anatomic reconstruction involved [12]. A learning curve probably exists even for experienced radiologists.…”

Utility of Routine Versus Selective Upper Gastrointestinal Series to Detect Anastomotic Leaks After Laparoscopic Gastric Bypass

“…Consequently, many centers, initially also our center, have suggested using a postoperative UGI contrast study on a routine basis [20]. However, the use of such tests on a routine basis after LRYGB is controversially discussed because of the additional costs and technical/methodological limitations, e.g., difficulties in monitoring contrast in obese patients [15,17,[21][22][23]. In this study, we have shown that routine upper gastrointestinal series have a very low sensitivity to detect a leakage at the gastrojejunostomy and did not result in an earlier detection of the leakage.…”

Abnormal Findings on Routine Upper GI Series following Laparoscopic Roux-en-Y Gastric Bypass

“…8 Some patients show evidence of severe gastroesophageal reflux. 15,16 UGI examinations are useful in depict-ing the postoperative anatomy. 12,13 Fistulation between the gastric pouch and bypassed stomach can also occur.…”