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Review
. 2011 Feb;84(998):101-11.
doi: 10.1259/bjr/18405029. Epub 2010 Nov 2.

Imaging in bariatric surgery: service set-up, post-operative anatomy and complications

S Shah  1 , V Shah, A R Ahmed, D M Blunt
Affiliations
Review

Imaging in bariatric surgery: service set-up, post-operative anatomy and complications

S Shah et al. Br J Radiol. 2011 Feb.

Abstract

Obesity is an increasingly prevalent and costly problem faced by the healthcare system. The role of bariatric surgery in managing obesity has also increased with evidence showing a reduction in long-term morbidity and mortality. There are unique challenges faced by the radiology department in providing an imaging service for this population of patients, from technical and staffing requirements through to the interpretation of challenging post-surgical images. We describe these challenges and provide an overview of the most frequently performed procedures, normal post-operative imaging findings and the appearance of common complications.

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Figures

Table 1
Table 1
National Institute for Health and Clinical Excellence guidance regarding surgical management of obesity [2]
Figure 1
Figure 1
Normal appearances following Roux-en-Y gastric bypass. (a) Schematic illustration; (b) contrast study; P, gastric pouch; A, alimentary limb; BL, blind limb; (c) CT image; P, gastric pouch; GR, gastric remnant.
Figure 2
Figure 2
Normal CT appearances following Roux-en-Y gastric bypass. (a) Antecolic position of alimentary limb; A, alimentary limb; TC, transverse colon; (b) jejunojejunal anastomosis; arrow shows the anastomosis between alimentary and biliopancreatic (BP) limbs.
Figure 3
Figure 3
Contrast study demonstrating leak at gastrojejunal anastomosis; arrow indicates leak; P, gastric pouch; A, alimentary limb.
Figure 4
Figure 4
Contrast studies demonstrating narrowing at gastrojejunal anastomosis. (a) Post-operative oedema: arrow indicates narrowing at gastrojejunal anastomosis; P, gastric pouch; A, alimentary limb; (b) stricture; arrow indicates stricture at gastrojejunal anastomosis; P, gastric pouch; A, alimentary limb.
Figure 5
Figure 5
Contrast study demonstrating jejunojejunal stricture; arrow indicates stricture at anastomosis between alimentary and biliopancreatic limbs; arrowhead indicates oedema in alimentary limb; A, alimentary limb; CC, common channel.
Figure 6
Figure 6
Contrast study demonstrating gastrogastric fistula; P, gastric pouch; A, alimentary limb; GR, gastric remnant.
Figure 7
Figure 7
Normal appearances following laparoscopic adjustable gastric banding. (a) Schematic illustration; (b) contrast study demonstrating phi angle; P, gastric pouch; arrow shows gastric band.
Figure 8
Figure 8
Contrast study demonstrating a megapouch (MP).
Figure 9
Figure 9
Contrast study demonstrating anterior pouch prolapse and increased phi angle; P, gastric pouch.
Figure 10
Figure 10
Normal appearances following sleeve gastrectomy. (a) Schematic illustration; (b) contrast study; S, gastric sleeve; (c) CT image; S, gastric sleeve; arrow shows gastric suture line.
Figure 11
Figure 11
Contrast study demonstrating a pitfall in imaging following sleeve gastrectomy; S, gastric sleeve; arrow indicates intraluminal contrast within fundus mimicking a leak.
Figure 12
Figure 12
Post-operative leak from gastric suture line following sleeve gastrectomy. (a) Contrast study; arrow indicates leak from gastric suture line; S, gastric sleeve; (b) CT; S, gastric sleeve; arrow indicates fluid collection in left upper quadrant.
See this image and copyright information in PMC

References

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