Three-dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration

Baumann, Tobias; Grueneberger, Jodok Matthias; Pache, Gregor; Kuesters, Simon; Marjanović, Goran; Kulemann, Birte; Holzner, Philipp; Karcz-Socha, Iwona; Sueßlin, D.; Hopt, Ulrich T.; Langer, Mathias; Karcz, Wojciech Konrad

doi:10.1007/s00464-010-1558-0

Cited by 108 publications

(52 citation statements)

References 27 publications

(38 reference statements)

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“…Thus, it appears useful to know the pre-and post-operative stomach volumes and to correlate it with weight loss achieved after LSG. Methods described in the literature range from intraoperative measurement by instillation of normal saline or methylene blue, UGI contrast series and MDCT [6][7][8][9][10]. In the present study, we used MDCT for estimating pre-and post-operative stomach volumes and found that MDCT correlates well with the volume of the excised stomach measured by saline distension.…”

Section: Discussionmentioning

confidence: 59%

“…Among the various methods described to determine sleeve volume like infusion of saline solution or methylene blue through orogastric tube [6,7], upper gastro-intestinal contrast [8] and multidetector computed tomography (MDCT) with post image processing, the latter has shown reasonable results [9,10]. Volume measurement with MDCT has been compared previously with UGI contrast studies and has shown comparable results [10].…”

Section: Resultsmentioning

confidence: 96%

“…Few studies have measured sleeve volume and described dilation of sleeve over time [9,10]. There are hardly any studies evaluating pre-operative stomach volume and volume of stomach excised during LSG.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Early post-operative weight loss after laparoscopic sleeve gastrectomy correlates with the volume of the excised stomach and not with that of the sleeve! Preliminary data from a multi-detector computed tomography-based study

et al. 2014

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Section: Discussionmentioning

confidence: 59%

Section: Resultsmentioning

confidence: 96%

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Early post-operative weight loss after laparoscopic sleeve gastrectomy correlates with the volume of the excised stomach and not with that of the sleeve! Preliminary data from a multi-detector computed tomography-based study

et al. 2014

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“…Mechanisms that may induce increased GERD in patients with GERD with sleeve gastrectomy include hypotensive LES (28), blunting of the angle of His (29), decreased gastric compliance (30), delayed gastric emptying (29), reduced plasma ghrelin levels (31), gastric sleeve anatomy (32), and hiatal hernia (33). In the cohort study by Himpens et al (34), GERD occurred at a rate of 23.6% at six years after surgery.…”

Section: Sleeve Gastrectomymentioning

confidence: 99%

Which diseases are risk factors for developing gastroesophageal reflux disease?

Akyüz

Soyer²

2017

Turk J Gastroenterol

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Gastroesophageal reflux disease (GERD) is known to present with various extraesophageal symptoms and complications. In contrast, several diseases affecting the motility of the esophagus and some approaches that alter the upper gastrointestinal tract anatomy may result in GERD. Certain diseases and conditions often mentioned with GERD will be briefly discussed in this section. Systemic SclerosisEsophageal motility is impaired in 70-90% of patients with systemic sclerosis (1-3). On histological examination, smooth muscle atrophy and fibrosis causing motor activity abnormalities in two-thirds of the distal esophagus are often determined (4). Motility studies have shown that the amplitude of peristaltic contractions decreases or that there is no peristaltic contraction in this region (5-7). Abnormal peristalsis and decreased lower esophageal sphincter (LES) pressure reduce acid clearance and prolong the contact of acid with the mucosa (8). As a result, GERD develops in patients with scleroderma. In many cross-sectional studies using different methodologies, the prevalence of GERD has been reported to be at rates of up to 70% (9-15). Diabetes MellitusFurthermore, various factors showing tendency to GERD were identified in diabetes mellitus. Among these,• Reduced salivary secretion associated with diabetic neuropathy, • Delayed gastric emptying, • Decreased acid clearance due to reduced motor activity of the esophagus/stomach related motor/autonomic neuropathy, • Increased sensory thresholds associated with sensory nerve damage of the esophagus, • Acid regurgitation caused by the increased frequency of transient LES relaxations related to neuropathy, CholecystectomyThe reservoir function of the gallbladder disappears after cholecystectomy, and bile flow becomes continuous (20,21). Qualitative changes may appear at the levels of gastrointestinal hormones (22,23). Consequently, alterations in the qualitative bile content and more frequent transient LES relaxation may occur (24). Moreover, it was thought that reflux symptoms in these patients worsen with increased biliary symptoms after cholecystectomy due to a high-fat diet intake and weight gain. Alterations in the motility of the upper gastrointestinal tract and delayed stomach emptying caused by duodenal adhesions may also contribute to GERD (25). There was no significant increase in reflux after cholecystectomy in the limited number of studies based on these data. Uyanıkoğlu et al. (26) used the impedance method and reported increased reflux after surgery and that the pH was <4% higher than that before surgery; however, it was similar to the control group. In another study, Lin et al. (27) compared patients with hernia surgery and cholecystectomy. Reduction in the reflux symptom score was 35% in patients, while it was 39% in controls (p=0.11). Sleeve GastrectomyMechanisms that may induce increased GERD in patients with GERD with sleeve gastrectomy include hypotensive LES (28), blunting of the angle of His (29), decreased gastric compliance (30), delayed gastric em...

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“…Under normal anatomic conditions, the stomach is fixed in place by four "ligaments", that is, the gastrohepatic, gastrosplenic, gastrocolic, and gastrophrenic ligaments, and laxity of these, the absence of omentum, paraesophageal hernia, or diaphragmatic eventrations increase the mobility and ability of the stomach to rotate organo-axially or mesentero-axially [14]. It has recently been reported that loss of abdominal ligament fixation along the greater curvature of the stomach may result in improper gastric pouch positioning and cause food intolerance and persistent reflux [15,16].…”

Section: Methodsmentioning

confidence: 99%

Does Contouring of the Sleeve Help Prevent de novo GERD after Laparoscopic Sleeve Gastrectomy? A Nonrandomized Study

Jeon

Kim

2017

J Metab Bariatr Surg

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Purpose: The authors undertook this study to compare their modified version of sleeve gastrectomy with conventional sleeve gastrectomy in terms of the severity and incidence of gastroesophageal reflux. Materials and Methods: This study was conducted for the patients that underwent primary laparoscopic sleeve gastrectomy in a single center from 2011 to 2015. Patients that underwent conventional LSG were allocated to Group A (n=46), and sleeve contouring gastrectomy to Group B (n=45). Postoperatively %EBMIL, PPI use, and endoscopy findings, and receipt of conversion surgery were compared. Results

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Three-dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration

Abstract: Multislice computed tomography allows for a comprehensive and quantitative evaluation of the anatomy after LSG and thus provides new insights in the process of sleeve dilation. Intrathoracic migration of the staple line could be identified as a possible cause of persistent regurgitation.

Cited by 108 publications

References 27 publications

Early post-operative weight loss after laparoscopic sleeve gastrectomy correlates with the volume of the excised stomach and not with that of the sleeve! Preliminary data from a multi-detector computed tomography-based study

Early post-operative weight loss after laparoscopic sleeve gastrectomy correlates with the volume of the excised stomach and not with that of the sleeve! Preliminary data from a multi-detector computed tomography-based study

Which diseases are risk factors for developing gastroesophageal reflux disease?

Does Contouring of the Sleeve Help Prevent de novo GERD after Laparoscopic Sleeve Gastrectomy? A Nonrandomized Study

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