Roux-En-Y Gastric Bypass Postsurgical Anatomy and Common Complications: A primer for residents

Congress:

ECR 2018

Poster Number:

C-0901

Type:

Educational Exhibit

Keywords:

Motility, Fistula, Eating disorders, Dynamic swallowing studies, Contrast agent-oral, Fluoroscopy, Gastrointestinal tract, Abdomen, Stomach (incl. Oesophagus)

Authors:

M. A. Serrano¹, L. M. Avila Escobedo², D. Butrón Hernández³; ¹Mexico/MX, ²México D.F./MX, ³Ciudad de Mexico/MX

DOI:

10.1594/ecr2018/C-0901

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-0901

Fig. 1: Roux-En-Y Gastric Bypass Postsurgical Anatomy and Common Complications: A...

Fig. 3: Types of Bariatric Surgery

Fig. 4: Roux-en-Y gastric bypass surgical technique

Fig. 7: Normal upper GI examination. The images show an adequate passage of water...

Fig. 13: Supine spot image from upper GI examination with water-soluble contrast...

Fig. 16: Immediate ppostsurgical upper GI examination. Images show narrowing of the...

Fig. 18: Small bowel obstruction. Coronal (A) and axial (B, C) CT images after oral and...

Learning objectives

To describe the routine technique of water soluble uper GI evaluation of patients undergoing Roux-En-Y gastric bypass To review the imaging findings of normal postoperative anatomy To recognize the main complications and its imaging features especially those life-threatening

Background

Introduction Obesity is an epidemic disease. It is one of the main causes of preventable death. In Mexico, according to 2012 Encuesta Nacional de Salud y Nutrición (ENSANUT), the prevalence of overweight and obesity in adults (Fig. 2) was 71.28% (representing 48.6 millon people).[1]Bariatric surgery is increasingly performed as a therapeutic alternative in obese patients who fail to lose weight with medical treatment. The recommendations to perform a surgery include the following criteria: a BMI of 40 or higher, or a BMI of 35 or...

Findings and procedure details

Postsurgical assessment and normal imaging findings The knowledge of postoperative anatomy is crucial to rule out complications in the immediate and late postoperative period, especially those that are life threatening. Each surgical technique has its own special characteristics and the different types of complications must be recognized.[4] Upper gastrointestinal examination is the modality of choice for immediate post-surgical evaluation of patients who have undergone this procedure, it has a specificity close to 100%.[7,8] In our institution it is performed routinely to all patients in the...

Conclusion

The laparoscopic Roux-en-Y gastric bypass has become the preferred method to treat obese patients who fail to lose weight with medical treatments, and may be considered the standard of reference for bariatric surgery. Radiologists should be familiar with the surgical anatomy and normal imaging findings for major bariatric procedures to rule out the most frequent complications, especially those are life threatening. Upper GI series and abdominal CT are the preferred methods to evaluate these patients at immediate post-surgical period. In many institutions a fluoroscopy upper...

Personal information

Radiology Department. Instituto Nacional de Nutrición y Ciencias Médicas Salvador Zubirán

References

Encuesta Nacional en Salud y Nutrición. Ensanut 2012. Inst Nac Salud Pública. 2012:200. doi:10.1017/CBO9781107415324.004. Buchwald H, Avidor Y, Braunwald E, et al.Bariatric surgery: A systematic review and meta-analysis.J Am Med Assoc. 2004;292(14):1724-1737. doi:10.1001/jama.292.14.1724. Monteforte MJ, Turkelson CM.Bariatric surgery for morbid obesity. Obes Surg. 2000;10(5):391-401. doi:10.1381/096089200321594246 Levine MS, Carucci LR.Imaging of Bariatric Surgery: Normal Anatomy and Postoperative Complications.Radiology. 2014;270(2):327-341. doi:10.1148/radiol.13122520 Schauer PR, Ikramuddin S, Hamad G, et al.Laparoscopic Gastric Bypass Surgery: Current Technique.J Laparoendosc Adv Surg Tech. 2003;13(4):229-239. doi:10.1089/109264203322333557. Scheirey CD, Scholz FJ, Shah PC, Brams...