Peer-review started: November 2, 2017
First decision: November 30, 2017
Revised: December 3, 2017
Accepted: January 25, 2018
Article in press: January 25, 2018
Published online: January 28, 2018
The laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most common bariatric procedure worldwide. In a majority of bariatric centres, postoperative upper gastrointestinal (UGI) contrast studies are performed routinely in order to evaluate for complications. The usefulness of UGI examinations is debatable considering its related radiation dose and the obtained diagnostic information.
Several studies have suggested the usefulness of computed tomography (CT) to investigate postoperative complications after LRYGB, but data on routinely performed CT after bariatric surgery are scarce. UGI contrast studies are insufficient to accurately assess certain postoperative surgical problems, such as hematoma or fluid collections, and have only limited sensitivity for correctly diagnosing a leak, whereas CT can clearly diagnose these complications.
The prospective study was conducted to assess the feasibility and usefulness of CT scan as a primary early postoperative radiological measure in patients who underwent LRYGB.
Sixty-one patients who underwent LRYGB received upper abdominal CT on postoperative day 1. Diluted water-soluble radiographic contrast-medium (50 mL) was administered to achieve gastric pouch distension without movement of the patient. 3D images were evaluated to assess postoperative complications and the radiation dose received was analysed.
In 61 patients who were included in the analysis, CT was feasible and there were no instances of aspiration or vomiting. In 7 patients, two upper abdominal scans were necessary as the pouch was not distended by contrast medium in the first acquisition. Radiologically, no leak and no relevant stenosis were found on the first postoperative day. These early postoperative CT findings were consistent with the findings at clinical follow-up 6 wk postoperatively, with no leaks, stenosis or obstructions being diagnosed. The average total dose length product in CT was 536.6 mGycm resulting in an average effective dose of 7.8 mSv.
Early LRYGB postoperative CT scan is feasible, with low morbidity, and provides more accurate anatomical information than standard upper gastrointestinal contrast study.
The main limitation of this study is the fact that no surgical complications, such as leaks or obstructions, occurred in our study population. Therefore, no statement can be made on the sensitivity or specificity of CT regarding these pathologies on the first postoperative day. From this point of view large trials are necessary to enable a statement on the sensitivity and specificity of CT in this patient cohort.