Fabio Garofalo, MD1, Karl Sayegh, MD2, Omar Abouzahr, MD1, Henri Atlas, MD1, Garneau Pierre, MD1, Ronald Denis, MD1, Michel Philie, MD1, Radu Pescarus, MD1. 1Hôpital Sacre-Coeur, 2McGill University Health Center
INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) has become the most common bariatric procedure worldwide. Despite its apparent simplicity, this bariatric procedure may lead to an unfavourable outcome through insufficient weight loss or weight regain. Among the different complications associated with the LSG, sleeve leak (1-2.5%), sleeve stenosis (0.7-3.5%) and hemorrhage (< 5%) are among the most frequent. The objective of this paper is to illustrate the imaging findings of insufficient weight loss or weight regain, as well as the common complications post LSG.
METHODS AND PROCEDURES: A search was performed through our prospectively maintained bariatric database in order to select and illustrate the most common failure patterns. LSG failure was classified as insufficient weight loss, weight regain and surgical complications. Computerized tomography (CT) scan and upper gastrointestinal series images were selected in order to highlight the various failure patterns.
RESULTS: Overall, twenty patients were selected from our bariatric database. Each patient was chosen to illustrate the major complications that can occur post LSG: staple line leak, abnormal angulation or stenosis, post-operative hemorrhage, gastro-esophageal reflux and splenic infarction. Various causes of insufficient weight loss or weight regain such as primary and secondary sleeve dilatations were also emphasized. Different treatment options in the armamentarium of the bariatric surgeon were also illustrated such as percutaneous drainage, endoscopic stenting with different stent types as well as surgical treatment options such as a Roux-en-Y fistulo-enterostomy for chronic fistula.
CONCLUSION: Given the tremendous increase in LSG procedures, surgeons will be faced with increasing numbers of post LSG complications. Radiological evaluation plays an essential role in recognizing the most frequent and feared complications of LSG such as gastric leaks and sleeve stenosis. Understanding the modified post sleeve gastrectomy surgical anatomy as well as the typical manifestations of post-surgical complications is essential in order to better serve this growing patient population.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80758
Program Number: P531
Presentation Session: Poster (Non CME)
Presentation Type: Poster
