title: 3D-MSCT gastric pouch volumetry in bariatric surgery-preliminary clinical results.
abstract: BACKGROUND
  Insufficient weight loss or persistent abdominal complaints are reasons for revisionary operations in bariatric surgery. The selection of the secondary procedure is influenced by clinical and by patho-anatomical factors like the size of the gastric pouch. The purpose of this study was to evaluate multi-slice computed tomography (MSCT)-based volumetric assessment of gastric pouches, gastric sleeves, and anastomoses in patients after bariatric surgery.
  
  
  METHODS
  Twenty-six patients after bariatric surgery received abdominal MSCT immediately after oral administration of an ionic contrast agent solution and intravenous administration of buthylscopalamine. Indications were insufficient weight loss after primary operation, persistent upper abdominal complaints, and decline of bariatric analysis and reporting outcomes system (BAROS) score. The gastric volumes, diameter of the gastrojejunostomy, and the proximal part of the Roux limb were measured on volume rendering images and freely angulated reformations.
  
  
  RESULTS
  Evaluation of gastric volumes was successful in 25 examinations (96%). The diameters of gastrojejunostomy as well as the dimensions of the Roux limb were evaluable in all cases. After gastric bypass surgery, a pouch volume >30 ml was found in ten, a widening of the gastrojejunostomy in eight, and a dilated Roux limb in six cases. Two patients presented a combination of a wide anastomosis and a strongly dilated Roux limb. Patients after biliopancreatic diversion had gastric volumes between 210 and 840 ml. Other findings were a fistula, an intragastral stenosis, and internal hernias.
  
  
  CONCLUSIONS
  MSCT allows crucial patho-anatomical measurements and provides helpful information for selecting the appropriate revisionary operation after bariatric surgery.
authors.affiliation: Department of General and Visceral Surgery, Albert-Ludwigs-University, Hugstetter Strasse 55, 79106, Freiburg, Germany. wojciech.karcz@uniklinik-freiburg.de
authors.forename: W K
authors.initials: WK
authors.lastname: Karcz
authors.forename: S
authors.initials: S
authors.lastname: Kuesters
authors.forename: G
authors.initials: G
authors.lastname: Marjanovic
authors.forename: D
authors.initials: D
authors.lastname: Suesslin
authors.forename: E
authors.initials: E
authors.lastname: Kotter
authors.forename: O
authors.initials: O
authors.lastname: Thomusch
authors.forename: U T
authors.initials: UT
authors.lastname: Hopt
authors.forename: G
authors.initials: G
authors.lastname: Felmerer
authors.forename: M
authors.initials: M
authors.lastname: Langer
authors.forename: T
authors.initials: T
authors.lastname: Baumann
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D005260:Female; D005471:Fluoroscopy; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D014057:Tomography, X-Ray Computed / Q000379:methods*; D017211:Treatment Failure; D015430:Weight Gain; D015431:Weight Loss; D055815:Young Adult