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
To evaluate upper abdominal computed tomography (CT) scan as primary follow-up after laparoscopic Roux-en-Y gastric bypass (LRYGB).
This prospective study was approved by the Ethical Committee of the State of Zurich, and informed consent was obtained from all patients. Sixty-one patients who underwent LRYGB received upper abdominal CT on postoperative day 1, with the following scan parameters: 0.6 mm collimation, 1.2 mm pitch, CareKV with reference 120 mAs and 120 kV, and 0.5 s rotation time. 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.
From the 70 patients initially enrolled in the study, 9 were excluded from analysis upon the intraoperative decision to perform a sleeve gastrectomy and not a LRYGB. In all of the 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. The most common surgical complication, superficial surgical site infections (n = 4), always occurred at the upper left trocar site, where the circular stapler had been introduced.
Early LRYGB postoperative multislice spiral CT scan is feasible, with low morbidity, and provides more accurate anatomical information than standard upper gastrointestinal contrast study.
Core tip: In most bariatric centres, a routine upper gastrointestinal (UGI) study is performed in the early postoperative period. Yet, the real value of a standard postoperative radiological exam after laparoscopic Roux-en-Y gastric bypass is debatable. From the available data, an UGI is not necessary as a standard postoperative exam and, similarly, a routine computed tomography (CT) scan might not be indicated. For patients who experience unexpectedly difficult surgery or abnormal postoperative clinical course, CT is the diagnostic tool of choice, especially considering that a number of patients with pathological findings in UGI contrast studies will additionally undergo CT scan.