Radiological contrast studies after vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGBP) in patients with morbid obesity. Study of the complications.
OBJECTIVE
The aim of the study was to evaluate the role of radiological upper gastroenteric studies to detect early and postoperative complications after gastric restrictive surgery for obesity.


METHODS
From October 1992 to October 2002, 650 patients submitted to vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGBP) underwent radiological follow-up to assess the presence of both early and late postoperative complications. The patients were 546 (84%) women and 104 (16%) men whose average weight was 125 kg (range: 78 to 218 kg). The average female age was 37 years (range: 17 to 69 years) and the average male age 36 (range: 19 to 64 years). Preoperative mean body mass index was 46 kg/m2 (range 31-78 kg/m2). The patients underwent radiological upper gastroenteric investigation employing water soluble contrast material between the 4th and 7th postoperative day. All patients underwent another late examination every year after surgery.


RESULTS
At 10 years follow-up in 620 patients submitted to modified Mason VBG we observed the following early postoperative complications: 16 cases (2.6%) of oedema of the stoma, six cases (0.9%) of gastro-oesophageal reflux, one case (0.2%) of staple-line disruption, and one case (0.2%) of intragastric haemorrhage. Late complications in VBG included 26 cases (4.2%) of staple-line disruption, four cases (0.6%) of kinked stomas, six cases (0.9%) of pouch dilatations, two cases (0.4%) of stomal stenosis and one case (0.2%) of gastro-oesophageal reflux. In 30 RYGBP patients we observed the following early postoperative complications: one case (0.8%) of dilated pouch, one case (0.8%) of oedema of the anastomosis and one case (0.8%) of anastomotic leak. Late postoperative complications in the 30 RYGBP patients included three cases (2.5%) of stomal ulcers and one case (0.8%) of gastro-oesophageal reflux. We also examined the annual incidence of complications in late follow-up.


CONCLUSIONS
Both early and late radiological studies after gastric bariatric surgery enable the detection of postoperative complications and provided morphological and volumetric data after VBG and RYGBP. Post-operative complications (gastric perforation, stomal stenosis, etc.) need to be emphasised and the clinical approach modified to enable suitable weight loss.
Mondeturo
Francesco
F
U.O. di Radiologia Nuove Patologie, Policlinico S. Orsola Malpighi, Bologna, Italy. monteduro@orsola-malpighi.med.unibo.it
Cappello
Ivanpietro
I
Mazzoni
Gianni
G
Barozzi
Libero
L
Ghetti
Antonella
A
Nottola
Daniela
D
Cariani
Stefano
S
Amenta
Enrico
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects*; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011859:Radiography; D013270:Stomach / Q000000981:diagnostic imaging* / Q000601:surgery*; D013997:Time Factors