Learning objectives
Radiological imaging is vital in postoperative evaluation and management of patients of bariatric surgery.
This pictorial review will provide the reader with a guide to:
1.
Postsurgical anatomy
2.
Common complications of bariatric surgery
The reader will develop an understanding of normal postsurgical anatomy and familiarity with imaging features of common postoperative complications.
Background
Bariatric surgery is on the rise worldwide.
It is increasingly being performed to control morbid obesity that is resistant to medical intervention.
Plain radiographs,
upper abdominal fluoroscopy and abdominal computed tomography are themost commonimaging modalities used to asses postoperative patients.
The most common bariatric procedures performed include:
1.
Laparoscopic Roux-en-Y gastric bypass surgery
Asmall part of the stomach is used to create a new stomach pouch.
The smaller stomach is connected directly to the middle portion of the jejunum,
bypassing the rest of the stomach...
Findings and procedure details
St.
Vincent's University Hospital is a tertiary referral centre for bariatric surgery in Ireland.
We have compiled a pictorial review of a number of recent interesting cases that have been performed here.
Complications after Roux-en-Y gastric bypass include:
1.
Bowel ischemia
2.
Small bowel obstruction
3.
Internal herniation
Early complications:
Anastomotic leak
GI bleed
Stomal ulceration
Early stricture
Late complications:
Internal hernia
Stomal ulceration
Stomal necrosis
Gastro-gastric fistula
In the case of expected internal herniation:
The management is as per bowel obstruction.
Insert NG tube...
Conclusion
Bariatric surgery is becoming increasingly common worldwide.
It is vital that the radiologist can accurately identify the postsurgical anatomy and postsurgical complications that may occur.
As a centre for bariatric surgery,
we encounter a large number of postoperative patients.
Our pictorial review demonstratedthe normal anatomy and common complications we see post operatively,
to give the reader the necessary radiological skills to make the correct diagnosis.
References
1.
https://www.ajronline.org/doi/full/10.2214/AJR.04.0655
2.
http://pubs.rsna.org/doi/abs/10.1148/rg.324115177
3.
https://radiopaedia.org/articles/roux-en-y-gastric-bypass-surgery
4.
https://radiopaedia.org/articles/gastric-band