Roux-en-Y gastric bypass surgery for morbid obesity: evaluation of leak into excluded stomach with upper gastrointestinal examination.
OBJECTIVE
To retrospectively evaluate the imaging features at upper gastrointestinal (GI) examination of leak into the excluded part of the stomach after the Roux-en-Y gastric bypass (RYGB) procedure and to determine the associated complications and consequences of acute versus delayed leak development.


METHODS
The institutional review board approved this HIPAA-compliant study; the need for informed consent was waived. Database review revealed 1655 upper GI studies performed over 6 years in 1282 patients after an RYGB procedure. Leak into the excluded stomach was diagnosed in 48 patients (39 women, nine men; age range, 29-62 years; mean age, 46 years); these patients formed our study group. Studies were analyzed by two radiologists in consensus for extent and pattern of leak into the excluded stomach and the presence of associated complications of extraluminal leak or fistula, obstruction, and acute distention of the excluded stomach. Chart review was performed to determine clinical course, treatment, associated complications, and outcome. Patients were divided into two categories on the basis of acute versus delayed development of leak into the excluded stomach. Acute leak into the excluded stomach was diagnosed within 2 months of surgery. Delayed leak occurred more than 2 months after surgery.


RESULTS
Leak into the excluded stomach occurred in the acute postoperative period (within 2 months) in 25 of the 48 patients (52%) and was associated with extraluminal leak in 22 of those 25 patients (88%). Acute leak into the excluded stomach healed in seven of the 25 patients (28%). Delayed postoperative leak into the excluded stomach occurred in 23 of the 48 patients (48%) and resulted in failed weight loss in 14 of those 23 patients (61%). Fourteen of the 48 patients (29%) underwent surgical revision for leak into the excluded stomach.


CONCLUSIONS
Leak into the excluded stomach was identified on upper GI studies in 48 of 1282 patients (3.7%) after RYGB for morbid obesity. Acute leak into the excluded stomach may heal spontaneously; however, remote postoperative leak into the excluded stomach can result in failed weight loss and subsequent failure of the RYGB procedure.
Department of Radiology, Virginia Commonwealth University Medical Center, 1250 E Marshall St, Main Hospital, 3rd Floor, Rm 417, PO Box 980615, Richmond, VA 23298-0615, USA. lcarucci@vcu.edu
Laura R
LR
Carucci
Robert C
RC
Conklin
Mary Ann
MA
Turner
D000328:Adult; D001466:Barium Sulfate; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D005260:Female; D005471:Fluoroscopy; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D041742:Upper Gastrointestinal Tract / Q000000981:diagnostic imaging*
D003287:Contrast Media; D001466:Barium Sulfate; D003974:Diatrizoate Meglumine