Use of computed tomography in diagnosis of major postoperative gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery

Abstract

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is becoming a frequently performed procedure for the treatment of morbid obesity. It is important for all general surgeons to be able to diagnose correctly and treat its complications. It is the purpose of this study to determine whether computed tomography (CT) is useful in correctly diagnosing these complications. The medical records of all patients that underwent LRYGB between March 2000 and December 2002 (n = 574) at Huntington Memorial Hospital were reviewed. Major abdominal complications defined as anastomotic leaks or small bowel obstruction were noted. Results of CT scans in these patients were reviewed by both a radiologist and an attending surgeon. CT scan findings were then compared to intraoperative findings. Postoperatively, 18 patients were found to have small bowel obstruction/herniation and anastomotic leaks. CT scan correctly diagnosed anastomotic leaks and small bowel obstruction in 71 per cent and 100 per cent of patients, respectively. Complication following LRYGB are rare but potentially life-threatening. CT scans are helpful in predicting the pathology and directing the surgical management of these patients. CT scan findings, however, can be subtle and therefore be missed by those not intimately familiar with post gastric bypass anatomy.