Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 4/2009

01-04-2009 | Modern Surgery: Technical Innovation

3D-MSCT Gastric Pouch Volumetry in Bariatric Surgery—Preliminary Clinical Results

Authors: W. K. Karcz, S. Kuesters, G. Marjanovic, D. Sueßlin, E. Kotter, O. Thomusch, U. T. Hopt, G. Felmerer, M. Langer, T. Baumann

Published in: Obesity Surgery | Issue 4/2009

Login to get access

Abstract

Background

Insufficient weight loss or persistent abdominal complaints are reasons for revisionary operations in bariatric surgery. The selection of the secondary procedure is influenced by clinical and by patho-anatomical factors like the size of the gastric pouch. The purpose of this study was to evaluate multi-slice computed tomography (MSCT)-based volumetric assessment of gastric pouches, gastric sleeves, and anastomoses in patients after bariatric surgery.

Methods

Twenty-six patients after bariatric surgery received abdominal MSCT immediately after oral administration of an ionic contrast agent solution and intravenous administration of buthylscopalamine. Indications were insufficient weight loss after primary operation, persistent upper abdominal complaints, and decline of bariatric analysis and reporting outcomes system (BAROS) score. The gastric volumes, diameter of the gastrojejunostomy, and the proximal part of the Roux limb were measured on volume rendering images and freely angulated reformations.

Results

Evaluation of gastric volumes was successful in 25 examinations (96%). The diameters of gastrojejunostomy as well as the dimensions of the Roux limb were evaluable in all cases. After gastric bypass surgery, a pouch volume >30 ml was found in ten, a widening of the gastrojejunostomy in eight, and a dilated Roux limb in six cases. Two patients presented a combination of a wide anastomosis and a strongly dilated Roux limb. Patients after biliopancreatic diversion had gastric volumes between 210 and 840 ml. Other findings were a fistula, an intragastral stenosis, and internal hernias.

Conclusions

MSCT allows crucial patho-anatomical measurements and provides helpful information for selecting the appropriate revisionary operation after bariatric surgery.
Literature
1.
Karlsson J, Taft C, Ryden A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes (Lond). 2007;31(8):1248–61.CrossRef
2.
Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.CrossRefPubMed
3.
van Gemert WG, van Wersch MM, Greve JW, et al. Revisional surgery after failed vertical banded gastroplasty: restoration of vertical banded gastroplasty or conversion to gastric bypass. Obes Surg. 1998;8(1):21–8.CrossRefPubMed
4.
5.
Gagner M, Gentileschi P, Pomp A, et al. Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg. 2002;12(2):254–60.CrossRefPubMed
6.
Favretti F, Segato G, De MF, et al. An adjustable silicone gastric band for laparoscopic treatment of morbid obesity—technique and results. Surg Technol Int. 2002;10:109–14.PubMed
7.
Forsell P. Pouch volume, stoma diameter and weight loss in Swedish adjustable gastric banding (SAGB). Obes Surg. 1996;6(6):468–73.CrossRefPubMed
8.
Baltasar A, Serra C, Perez N, et al. Laparoscopic sleeve gastrectomy: a multipurpose bariatric operation. Obes Surg. 2005;15(8):1124–8.CrossRefPubMed
9.
Johnston D, Dachtler J, Sue-Ling HM, et al. The Magenstrasse and Mill operation for morbid obesity. Obes Surg. 2003;13(1):10–6.CrossRefPubMed
10.
Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg. 2008;18:487–96.CrossRefPubMed
11.
Weiner RA, Weiner S, Pomhoff I, et al. Laparoscopic sleeve gastrectomy—influence of sleeve size and resected gastric volume. Obes Surg. 2007;17(10):1297–305.CrossRefPubMed
12.
Madan AK, Harper JL, Tichansky DS. Techniques of laparoscopic gastric bypass: on-line survey of American Society for Bariatric Surgery Practicing Surgeons. Surg Obes Relat Dis. 2008;4(2):166–72.CrossRefPubMed
13.
Roberts K, Duffy A, Kaufman J, et al. Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21(8):1397–402.CrossRefPubMed
14.
Schwartz RW, Strodel WE, Simpson WS, et al. Gastric bypass revision: lessons learned from 920 cases. Surgery 1988;104(4):806–12.PubMed
15.
Muller MK, Wildi S, Scholz T, et al. Laparoscopic pouch resizing and redo of gastro-jejunal anastomosis for pouch dilatation following gastric bypass. Obes Surg. 2005;15(8):1089–95.CrossRefPubMed
16.
Gagner M, Rogula T. Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg. 2003;13(4):649–54.CrossRefPubMed
17.
Weiss HG, Kirchmayr W, Klaus A, et al. Surgical revision after failure of laparoscopic adjustable gastric banding. Br J Surg. 2004;91(2):235–41.CrossRefPubMed
18.
Wolf AM, Falcone AR, Kortner B, et al. BAROS: an effective system to evaluate the results of patients after bariatric surgery. Obes Surg. 2000;10(5):445–50.CrossRefPubMed
19.
Karcz WK, Baumann T, Marjanovic G, et al. To have or not to have the ring: early and late surgical complications after banded Roux-en-Y gastric bypass. Videosurgery and Other Miniinvasive Techniques. 2008;3(2):53–5.
20.
Fobi MA. Placement of the GaBP ring system in the banded gastric bypass operation. Obes Surg. 2005;15(8):1196–201.CrossRefPubMed
21.
Weber M, Muller MK, Michel JM, et al. Laparoscopic Roux-en-Y gastric bypass, but not rebanding, should be proposed as rescue procedure for patients with failed laparoscopic gastric banding. Ann Surg. 2003;238(6):827–33.CrossRefPubMedPubMedCentral
22.
Topart P, Becouarn G, Ritz P. Biliopancreatic diversion with duodenal switch or gastric bypass for failed gastric banding: retrospective study from two institutions with preliminary results. Surg Obes Relat Dis. 2007;3(5):521–5.CrossRefPubMed
23.
Pareja JC, Pilla VF, Callejas-Neto F, et al. Gastric bypass Roux-en-Y gastrojejunostomy—conversion to distal gastrojejunoileostomy for weight loss failure—experience in 41 patients. Arq Gastroenterol. 2005;42(4):196–200.CrossRefPubMed
24.
Sugerman HJ, Kellum JM, DeMaria EJ. Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity. J Gastrointest Surg. 1997;1(6):517–24.CrossRefPubMed
25.
Fobi MA, Lee H, Igwe D, et al. Revision of failed gastric bypass to distal Roux-en-Y gastric bypass: a review of 65 cases. Obes Surg. 2001;11(2):190–5.CrossRefPubMed
26.
Parikh M, Pomp A, Gagner M. Laparoscopic conversion of failed gastric bypass to duodenal switch: technical considerations and preliminary outcomes. Surg Obes Relat Dis. 2007;3(6):611–8.CrossRefPubMed
27.
Gumbs AA, Margolis B, Bessler M. Laparoscopic banded-Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006;2(3):408–9.CrossRefPubMed
28.
Flanagan L. Measurement of functional pouch volume following the gastric bypass procedure. Obes Surg. 1996;6(1):38–43.CrossRefPubMed
29.
Forsell P, Hellers G, Laveskog U, et al. Validation of pouch size measurement following the Swedish adjustable gastric banding using endoscopy, MRI and barium swallow. Obes Surg. 1996;6(6):463–7.CrossRefPubMed
30.
Naslund I. A method for measuring the size of the gastric outlet in obesity surgery. Acta Chir Scand. 1984;150(5):399–404.PubMed
31.
Nishie A, Brown B, Barloon T, et al. Comparison of size of proximal gastric pouch and short-term weight loss following routine upper gastrointestinal contrast study after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17(9):1183–8.CrossRefPubMed
32.
33.
Langer FB, Bohdjalian A, Felberbauer FX, et al. Does gastric dilatation limit the success of sleeve gastrectomy as a sole operation for morbid obesity? 2006;2:166–71.
Metadata
Title
3D-MSCT Gastric Pouch Volumetry in Bariatric Surgery—Preliminary Clinical Results
Authors
W. K. Karcz
S. Kuesters
G. Marjanovic
D. Sueßlin
E. Kotter
O. Thomusch
U. T. Hopt
G. Felmerer
M. Langer
T. Baumann
Publication date
01-04-2009
Publisher
Springer New York
Published in
Obesity Surgery / Issue 4/2009
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-008-9776-4

Other articles of this Issue 4/2009

Obesity Surgery 4/2009 Go to the issue

Research Article

Obesity Surgery Results Depending on Technique Performed: Long-Term Outcome

Research Article

Vagal Nerve Dissection During Pouch Formation in Laparoscopic Roux-Y-Gastric Bypass for Technical Simplification: Does it Matter?

Research Article

Age ≥50 Does Not Influence Outcome in Laparoscopic Gastric Banding

Research Article

High Complication Rate after Swedish Adjustable Gastric Banding in Younger Patients ≤25 Years

Research Article

Limb Contouring after Massive Weight Loss: Functional Rather than Aesthetic Improvement

New Concepts

Laparoscopic Seromyotomy for Long Stenosis After Sleeve Gastrectomy with or Without Duodenal Switch