The role of early radiological studies after gastric bariatric surgery.
BACKGROUND
The authors investigated early radiological findings after gastric surgery for morbid obesity to evaluate their usefulness in avoiding complications or facilitating treatment.


METHODS
413 patients underwent gastric bariatric surgery: 327 had vertical banded gastroplasty (VBG), 55 Roux-en-Y gastric bypass (RYGBP), 22 adjustable silicone gastric banding (ASGB), and 9 biliopancreatic diversion (BPD). A radiological upper gastrointestinal investigation employing water-soluble contrast medium was performed in each patient between the 2nd and 8th postoperative day. Several techniques were employed to assess different radiological findings related to the anatomic modifications after the bariatric surgery.


RESULTS
In VBGs, delayed emptying was found in 10 patients (3%), gastric leak in 3 patients (0.9%), vertical suture breakdown in 1 patients (0.3%), and a wide pouch in 4 patients (1.2%). In RYGBP, a leak was detected in 2 patients (3.6%), delayed emptying in 2 (3.6%), and a wide pouch in 5 (9.1%). ASGB required band enlargement for stomal stenosis in 6 patients (27.2%). Temporary delayed emptying from stomal stenosis was also observed in 2 BPDs (22.2%). Overall complications were 35/413 (8.2%). Two cases of gastric leak after VBG were reoperated. Stomal stenosis after ASGB were treated by percutaneous band deflation; other cases were medically treated until complete healing.


CONCLUSIONS
Early radiological study after gastric bariatric surgery is advisable, since it detected postoperative complications (gastric perforation, stomal stenosis, etc.) and modified the clinical approach. As the interpretation of these radiographs is often difficult, involving different projections or patient's positions or other technical managements, surgeons and radiologists must interact and be knowledgable.
Toppino
M
M
Dipartimento Discipline Medico Chirurgiche, Clinica Chirurgica Generale ed Oncologica, c.so Dogliotti 14, Torino 10126, Italy. toppino@ddmc.unito.it
Cesarani
F
F
Comba
A
A
Denegri
F
F
Mistrangelo
M
M
Gandini
G
G
Morino
F
F
D015904:Biliopancreatic Diversion / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D005746:Gastric Emptying; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007479:Iopamidol; D009767:Obesity, Morbid / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods* / Q000592:standards; D011859:Radiography; D012086:Reoperation / Q000706:statistics & numerical data; D013270:Stomach / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome
D003287:Contrast Media; D003974:Diatrizoate Meglumine; D007479:Iopamidol