title: Three-dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is frequently performed as a definitive bariatric procedure today. Quantitative data on the detailed anatomy of the stomach after LSG are yet sparse.
  
  
  METHODS
  Thirty-two multislice computed tomography (MSCT) data sets acquired in 27 LSG patients (22 female, 5 male) with a dedicated examination protocol and post-processing were evaluated for gastric volume, stomach length, sleeve length, antrum length, staple line length, and maximum cross-sectional sleeve area. Obtained parameters were compared to time after surgery, weight loss, and the occurrence of postsurgical regurgitation.
  
  
  RESULTS
  Mean gastric volume was 186.5±88.4 ml. Gastric volume correlated significantly with the time interval after surgery. Sleeve sizes of 105.3±30.2 ml during early follow-up confirmed correct primary sizing of the sleeve, whereas marked dilation to 196.8±84.3 ml was found in patients with a follow-up of 6 months and longer (p=0.038). Sleeve area and staple line length were also positively correlated with time after surgery. No correlation was found between gastric volume and excess weight loss. In ten patients an intrathoracic migration of the staple line could be noted, with four of these patients developing persistent regurgitation after LSG. Regurgitation was present in only 2 of 17 patients without sleeve herniation.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Diagnostic Radiology, University Hospital Freiburg, Albert-Ludwigs-University, Hugstetter Straße 55, 79106, Freiburg, Germany. tobias.baumann@uniklinik-freiburg.de
authors.forename: Tobias
authors.initials: T
authors.lastname: Baumann
authors.forename: Jodok
authors.initials: J
authors.lastname: Grueneberger
authors.forename: Gregor
authors.initials: G
authors.lastname: Pache
authors.forename: Simon
authors.initials: S
authors.lastname: Kuesters
authors.forename: Goran
authors.initials: G
authors.lastname: Marjanovic
authors.forename: Birte
authors.initials: B
authors.lastname: Kulemann
authors.forename: Philipp
authors.initials: P
authors.lastname: Holzner
authors.forename: Iwona
authors.initials: I
authors.lastname: Karcz-Socha
authors.forename: Dorothea
authors.initials: D
authors.lastname: Suesslin
authors.forename: Ulrich T
authors.initials: UT
authors.lastname: Hopt
authors.forename: Mathias
authors.initials: M
authors.lastname: Langer
authors.forename: Wojciech K
authors.initials: WK
authors.lastname: Karcz
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D013270:Stomach / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome