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CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2021; 04(02): 109-126
DOI: 10.1055/s-0041-1725240
Review Article

Role of Imaging in Bariatric Surgery: A Review of the Various Surgical Techniques and Their Complications

Bhavana Girishekar 
1   Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
,
Sudarshan Rawat
1   Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
,
Rupa Ananthasivan
1   Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
,
Pramesh Reddy
1   Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
,
Pooja Patil
1   Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
,
Kavya Kaushik
1   Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
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Abstract

According to the World Health Organization, obesity has reached epidemic proportions globally, with at least 2.8 million people dying each year as a result of being overweight or obese. Bariatric surgery is being increasingly used as a form of treatment, particularly in those patients where lifestyle modifications are deemed insufficient. With the role of radiologists transitioning from a medical to a surgical evaluation in obesity, it is becoming increasingly important to familiarize oneself with the various imaging techniques used in the preoperative and postsurgical evaluation in such cases. This article aims to review the various surgeries performed, their normal imaging appearance, and the various complications that could be encountered.

Keywords

bariatric surgery - gastric banding - obesity - roux-en-y gastric bypass - sleeve gastrectomy


Publication History

Article published online:
02 March 2021

© 2021. Indian Society of Gastrointestinal and Abdominal Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Bariatric surgery in India Evidence Summary Tool. Available at http://www.ifso-apc.com/pdf/bariatric-surgery-in-india-evidence-summary-tool.pdf. Accessed April 8, 2020.
  • 2 Obesity and overweight. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed April 6, 2020.
  • 3 Bhardwaj S, Misra A, Misra R. et al. High prevalence of abdominal, intra-abdominal and subcutaneous adiposity and clustering of risk factors among urban Asian Indians in North India. PLoS One 2011; 6 (09) e24362
    CrossrefPubMedGoogle Scholar
  • 4 Singh AK, Singh R, Kota SK. Bariatric surgery and diabetes remission: who would have thought it?. Indian J Endocrinol Metab 2015; 19 (05) 563-576
    CrossrefPubMedGoogle Scholar
  • 5 Ramos A, Fasmbs F, Kow L, et al. The IFSO Global Registry 5th IFSO Global Registry Report. Available at: https://www.ifso.com/pdf/5th-ifso-global-registry-report-september-2019.pdf. Accessed April 28, 2020
  • 6 Benalcazar DA, Cascella M. Obesity surgery pre-op assessment and preparation. Available at: http://www.ncbi.nlm.nih.gov/pubmed/31536273. Accessed April 29, 2020.
  • 7 Schlottmann F, Buxhoeveden R. Laparoscopic Roux-en-Y gastric bypass: surgical technique and tips for success. J Laparoendosc Adv Surg Tech A 2018; 28 (08) 938-943
    CrossrefPubMedGoogle Scholar
  • 8 Pescatori LC, Savarino E, Mauri G. et al. Quantification of visceral adipose tissue by computed tomography and magnetic resonance imaging: reproducibility and accuracy. Radiol Bras 2019; 52 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 9 Torriani M, Oliveira AL, Azevedo DC, Bredella MA, Yu EW. Effects of Roux-en-Y gastric bypass surgery on visceral and subcutaneous fat density by computed tomography. Obes Surg 2015; 25 (02) 381-385
    CrossrefPubMedGoogle Scholar
  • 10 Merlotti C, Ceriani V, Morabito A, Pontiroli AE. Subcutaneous fat loss is greater than visceral fat loss with diet and exercise, weight-loss promoting drugs and bariatric surgery: a critical review and meta-analysis. Int J Obes 2017; 41 (05) 672-682
    CrossrefPubMedGoogle Scholar
  • 11 Gloy VL, Briel M, Bhatt DL. et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ 2013; 347: f5934-f5934
    CrossrefPubMedGoogle Scholar
  • 12 Wu F-Z, Huang Y-L, Wu CC. et al. Differential effects of bariatric surgery versus exercise on excessive visceral fat deposits. Medicine (Baltimore) 2016; 95 (05) e2616-e2616
    CrossrefPubMedGoogle Scholar
  • 13 Gumbs AA, Gagner M, Dakin G, Pomp A. Sleeve gastrectomy for morbid obesity. Obes Surg 2007; 17 (07) 962-969
    CrossrefPubMedGoogle Scholar
  • 14 Levine MS, Carucci LR. Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology 2014; 270 (02) 327-341
    CrossrefPubMedGoogle Scholar
  • 15 Riaz RM, Myers DT, Williams TR. Multidetector CT imaging of bariatric surgical complications: a pictorial review. Abdom Radiol (NY) 2016; 41 (01) 174-188
    CrossrefPubMedGoogle Scholar
  • 16 Lehnert B, Moshiri M, Osman S. et al. Imaging of complications of common bariatric surgical procedures. Radiol Clin North Am 2014; 52 (05) 1071-1086
    CrossrefPubMedGoogle Scholar
  • 17 Higa KD, Boone KB, Ho T, Davies OG. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg 2000; 135 (09) 1029-1033
    CrossrefPubMedGoogle Scholar
  • 18 Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000; 232 (04) 515-529
    CrossrefPubMedGoogle Scholar
  • 19 Fisher BL, Schauer P. Medical and surgical options in the treatment of severe obesity. Am J Surg 2002; 184 (6B) 9S-16S
    CrossrefPubMedGoogle Scholar
  • 20 DeMaria EJ, Sugerman HJ, Kellum JM, Meador JG, Wolfe LG. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 2002; 235 (05) 640-645
    CrossrefPubMedGoogle Scholar
  • 21 Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients–what have we learned?. Obes Surg 2000; 10 (06) 509-513
    CrossrefPubMedGoogle Scholar
  • 22 Al AB Harakeh, Kallies KJ, Borgert AJ, Kothari SN. Bowel obstruction rates in antecolic/antegastric versus retrocolic/retrogastric Roux limb gastric bypass: a meta-analysis. Surg Obes Relat Dis 2016; 12 (01) 194-198
    CrossrefPubMedGoogle Scholar
  • 23 Escalona A, Devaud N, Pérez G. et al. Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study. Surg Obes Relat Dis 2007; 3 (04) 423-427
    CrossrefPubMedGoogle Scholar
  • 24 Aghajani E, Jacobsen HJ, Nergaard BJ, Hedenbro JL, Leifson BG, Gislason H. Internal hernia after gastric bypass: a new and simplified technique for laparoscopic primary closure of the mesenteric defects. J Gastrointest Surg 2012; 16 (03) 641-645
    CrossrefPubMedGoogle Scholar
  • 25 Yazgan Ç, Balcı S, Özmen M. Post-operative imaging of baraitric surgery: What radiologists needs to know. EC Gastroenterol Dig Syst 2018; 5 (10) 776-786
    Google Scholar
  • 26 Ballesta C, Berindoague R, Cabrera M, Palau M, Gonzales M. Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2008; 18 (06) 623-630
    CrossrefPubMedGoogle Scholar
  • 27 Fernanda S, Mazzariol MD, Ellen L, Wolf M. Bariatric/metabolic surgery for the radiologist-part 2: laparoscopic Roux-en-Y gastric bypass. Appl Radiol 2016; 45 (12) 7-15
    Google Scholar
  • 28 Blachar A, Federle MP. Gastrointestinal complications of laparoscopic roux-en-Y gastric bypass surgery in patients who are morbidly obese: findings on radiography and CT. AJR Am J Roentgenol 2002; 179 (06) 1437-1442
    CrossrefPubMedGoogle Scholar
  • 29 Tucker ON, Escalante-Tattersfield T, Szomstein S, Rosenthal RJ. The ABC System: a simplified classification system for small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2007; 17 (12) 1549-1554
    CrossrefPubMedGoogle Scholar
  • 30 Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg 2003; 13 (03) 350-354
    CrossrefPubMedGoogle Scholar
  • 31 Carucci LR, Turner MA, Shaylor SD. Internal hernia following Roux-en-Y gastric bypass surgery for morbid obesity: evaluation of radiographic findings at small-bowel examination. Radiology 2009; 251 (03) 762-770
    CrossrefPubMedGoogle Scholar
  • 32 Dilauro M, McInnes MDF, Schieda N. et al. Internal hernia after laparoscopic Roux-en-Y gastric bypass: optimal CT Signs for diagnosis and clinical decision making. Radiology 2017; 282 (03) 752-760
    CrossrefPubMedGoogle Scholar
  • 33 Lockhart ME, Tessler FN, Canon CL. et al. Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR Am J Roentgenol 2007; 188 (03) 745-750
    CrossrefPubMedGoogle Scholar
  • 34 Goodman P, Halpert RD. Radiological evaluation of gastric stapling procedures for morbid obesity. Crit Rev Diagn Imaging 1991; 32 (01) 37-67
    PubMedGoogle Scholar
  • 35 Hainaux B, Agneessens E, Rubesova E. et al. Intragastric band erosion after laparoscopic adjustable gastric banding for morbid obesity: imaging characteristics of an underreported complication. AJR Am J Roentgenol 2005; 184 (01) 109-112
    CrossrefPubMedGoogle Scholar
  • 36 Vinzens F, Kilchenmann A, Zumstein V, Slawik M, Gebhart M, Peterli R. Long-term outcome of laparoscopic adjustable gastric banding (LAGB): results of a Swiss single-center study of 405 patients with up to 18 years’ follow-up. Surg Obes Relat Dis 2017; 13 (08) 1313-1319
    CrossrefPubMedGoogle Scholar
  • 37 Aarts EO, Dogan K, Koehestanie P, Aufenacker TJ, Janssen IMC, Berends FJ. Long-term results after laparoscopic adjustable gastric banding: a mean fourteen year follow-up study. Surg Obes Relat Dis 2014; 10 (04) 633-640
    CrossrefPubMedGoogle Scholar
  • 38 Clayton RD, Carucci LR. Imaging following bariatric surgery: roux-en-Y gastric bypass, laparoscopic adjustable gastric banding and sleeve gastrectomy. Br J Radiol 2018; 91 (1089) 2018-0031
    Google Scholar
  • 39 Wiesner W, Schöb O, Hauser RS, Hauser M. Adjustable laparoscopic gastric banding in patients with morbid obesity: radiographic management, results, and postoperative complications. Radiology 2000; 216 (02) 389-394
    CrossrefPubMedGoogle Scholar
  • 40 DeMaria EJ, Sugerman HJ, Meador JG. et al. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg 2001; 233 (06) 809-818
    CrossrefPubMedGoogle Scholar
  • 41 Frigg A, Peterli R, Zynamon A, Lang C, Tondelli P. Radiologic and endoscopic evaluation for laparoscopic adjustable gastric banding: preoperative and follow-up. Obes Surg 2001; 11 (05) 594-599
    CrossrefPubMedGoogle Scholar
  • 42 Chevallier J-M, Zinzindohoué F, Douard R. et al. Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1,000 patients over 7 years. Obes Surg 2004; 14 (03) 407-414
    CrossrefPubMedGoogle Scholar
  • 43 Pieroni S, Sommer EA, Hito R, Burch M, Tkacz JN. The “O” sign, a simple and helpful tool in the diagnosis of laparoscopic adjustable gastric band slippage. AJR Am J Roentgenol 2010; 195 (01) 137-141
    CrossrefPubMedGoogle Scholar
  • 44 Sonavane SK, Menias CO, Kantawala KP. et al. Laparoscopic adjustable gastric banding: what radiologists need to know. Radiographics 2012; 32 (04) 1161-1178
    CrossrefPubMedGoogle Scholar
  • 45 Prosch H, Tscherney R, Kriwanek S, Tscholakoff D. Radiographical imaging of the normal anatomy and complications after gastric banding. Br J Radiol 2008; 81 (969) 753-757
    CrossrefPubMedGoogle Scholar
  • 46 O’Brien PE, Dixon JB. Lap-band: outcomes and results. J Laparoendosc Adv Surg Tech A 2003; 13 (04) 265-270
    CrossrefPubMedGoogle Scholar
  • 47 Mortelé KJ, Pattijn P, Mollet P. et al. The Swedish laparoscopic adjustable gastric banding for morbid obesity: radiologic findings in 218 patients. AJR Am J Roentgenol 2001; 177 (01) 77-84
    CrossrefPubMedGoogle Scholar
  • 48 Zakaria EA. Laparoscopic one-anastomosis gastric bypass: results of the first 310 patients. Egypt J Surg 2019; 38 (03) 406
    Google Scholar
  • 49 Wang F-G, Yu Z-P, Yan W-M, Yan M, Song M-M. Comparison of safety and effectiveness between laparoscopic mini-gastric bypass and laparoscopic sleeve gastrectomy: A meta-analysis and systematic review. Medicine (Baltimore) 2017; 96 (50) e8924-e8924
    CrossrefPubMedGoogle Scholar
  • 50 Carbajo M, García-Caballero M, Toledano M, Osorio D, García-Lanza C, Carmona JA. One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg 2005; 15 (03) 398-404
    CrossrefPubMedGoogle Scholar
  • 51 Park HJ, Hong SS, Hwang J, Hur KY. Mini-gastric bypass to control morbid obesity and diabetes mellitus: what radiologists need to know. Korean J Radiol 2015; 16 (02) 325-333
    CrossrefPubMedGoogle Scholar
  • 52 Lee WJ, Ser KH, Lee YC, Tsou JJ, Chen SC, Chen JC. Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg 2012; 22 (12) 1827-1834
    CrossrefPubMedGoogle Scholar
  • 53 Mostafa, Wahab, EMA, Sayed, YGA, Gafar, MH. . Laparoscopic sleeve gastrectomy versus laparoscopic mini-gastric bypass in management of morbid obesity and its comorbidities. Menoufia Med J 2018; 31 (04) 1181
    Google Scholar
  • 54 Nabil T, Hussein A, Nabil A. Comparative study between the complications of laparoscopic sleeve gastrectomy and laparoscopic mini-gastric bypass. Egypt J Surg 2017; 36 (04) 360
    CrossrefGoogle Scholar
  • 55 Kansou G, Lechaux D, Delarue J. et al. Laparoscopic sleeve gastrectomy versus laparoscopic mini gastric bypass: One year outcomes. Int J Surg 2016; 33 (01) 18-22
    CrossrefPubMedGoogle Scholar
  • 56 Noun R, Skaff J, Riachi E, Daher R, Antoun NA, Nasr M. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg 2012; 22 (05) 697-703
    CrossrefPubMedGoogle Scholar
  • 57 Kular KS, Manchanda N, Rutledge R. Analysis of the five-year outcomes of sleeve gastrectomy and mini gastric bypass: a report from the Indian sub-continent. Obes Surg 2014; 24 (10) 1724-1728
    CrossrefPubMedGoogle Scholar
  • 58 Chaim EA, Ramos AC, Cazzo E. MINI-gastric bypass: description of the technique and preliminary results. Arq Bras Cir Dig 2017; 30 (04) 264-266
    CrossrefPubMedGoogle Scholar
  • 59 Sumer A, Aktokmakyan TV, Peksen C. Mini gastric by-pass and bridged mini gastric by-pass: what is new? Available at: http://ales.amegroups.com/article/view/5599. Accessed January 7, 2020
  • 60 Weiss CR, Akinwande O, Paudel K. et al. Clinical safety of bariatric arterial embolization: preliminary results of the BEAT obesity trial. Radiology 2017; 283 (02) 598-608
    CrossrefPubMedGoogle Scholar
  • 61 Weiss CR, Abiola GO, Fischman AM. et al. bariatric embolization of arteries for the treatment of obesity (BEAT obesity) trial: results at 1 year. Radiology 2019; 291 (03) 792-800
    CrossrefPubMedGoogle Scholar
  • 62 Fernandes M, Atallah ÁN, Soares BG. et al. Intragastric balloon for obesity. Cochrane Database Syst Rev 2007; (01) CD00-4931
    Google Scholar
  • 63 Saber AA, Shoar S, Almadani MW. et al. Efficacy of first-time intragastric balloon in weight loss: a systematic review and meta-analysis of randomized controlled trials. Obes Surg 2017; 27 (02) 277-287
    CrossrefPubMedGoogle Scholar
  • 64 Bariatric intragastric ballon. Available at: https://radiopaedia.org/cases/62114intragastric-ballon. Accessed October 19, 2020