Biomedical subjects

Eric J DeMaria

Publications and source records attributed to Eric J DeMaria.

At least 19 recordsLinked to original sources

PubMed2006

Surgical revision of loop ("mini") gastric bypass procedure: multicenter review of complications and conversions to Roux-en-Y gastric bypass.

BACKGROUND: The claim that the "mini"-gastric bypass (MGB) procedure with its loop gastrojejunostomy is safer and equally effective to the Roux-en-Y gastric bypass (RYGB) procedure has been promoted before validation. Rumors of unreported complications and the accuracy of follow-up are additional concerns. This study was undertaken to identify MGB patients who require or required revisional surgery at 5 hospitals within the region of the United States where the MGB procedure originated to assess the claim that revision to RYGB is rarely needed. METHODS: The databases of 5 medical centers were retrospectively searched to identify patients undergoing surgical revision after a MGB procedure, all of which had been done elsewhere. RESULTS: A total of 32 patients were identified who presented with complications after undergoing an MGB procedure and required or require revisional surgery. The complications included gastrojejunostomy leak in 3, bile reflux in 20, intractable marginal ulcer in 5, malabsorption/malnutrition in 8, and weight gain in 2. Of the 32 patients, 21 required conversion to RYGB and an additional 5 have planned revisions in the future. Also, 2 patients were treated with Braun enteroenterostomies and 4 required 1 or more abdominal explorations. CONCLUSIONS: The results of this preliminary review have confirmed that MGB does require revision in some patients and that conversion to RYGB is a common form of revision. A national registry to record the complications and number of revisions is proposed to gain insight into the need for revision after MGB and other nontraditional bariatric procedures.

Databases as Topic↗

PubMed2006

Pulmonary embolism complicating bariatric surgery: detailed analysis of a single institution's 24-year experience.

BACKGROUND: Morbidly obese patients undergoing bariatric procedures are at risk for pulmonary embolism (PE). Because large series are required to analyze low-incidence complications, factors predictive of PE have not been clearly defined. Since 1992, short-course heparin prophylaxis, beginning immediately before operation, has been used in this center. STUDY DESIGN: Prospective data on 3,861 patients undergoing bariatric procedures between 1980 and 2004 were queried. Factors analyzed included age, gender, body mass index, interval between procedure and PE, inpatient versus outpatient status, mortality, access method (open versus laparoscopic), and comorbidities. RESULTS: PE within 60 days of operation occurred in 33 patients (23 women, 10 men), for an incidence of 0.85%. No difference in incidence was noted between open (0.84%) and laparoscopic (0.88%) groups, nor did routine prophylaxis with heparin since 1992 decrease the incidence. The interval between procedure and PE was 13.2+/-2.6 (mean +/- SEM) days (open=13.0+/-3.0 days, laparoscopic 14.1+/-6.49 days, p=0.9). One-third of PEs occurred after hospital discharge. Pulmonary embolism-related mortality was 27%. A statistically greater body mass index was noted in PE patients compared with non-PE patients (57.2+/-2.4 kg.m(2) versus 49.9+/-0.2 kg/m(2), p < 0.01, Wilcoxon rank test). Multivariate logistic regression confirmed a primary role for preoperative weight as a predictor of PE; univariate analysis suggested an increased PE risk with obesity hypoventilation syndrome, anastomotic leak, and chronic venous insufficiency. CONCLUSIONS: Data demonstrated persistence of PE risk in the anticoagulation, laparoscopic-access era at a rate similar to that in the preanticoagulation, open-access era. Because one-third of PEs occur after hospital discharge, consideration should be given to continuing anticoagulants longer and to adopting a more aggressive policy of inferior vena cava filter prophylaxis, particularly in patients with high body mass index, obese hyperventilation syndrome, and venous insufficiency.

Adolescent↗

PubMed2006

Physical activity stage of readiness predicts moderate-vigorous physical activity participation among morbidly obese gastric bypass surgery candidates.

BACKGROUND: Despite the ever-growing body of literature linking stage of physical activity readiness (PAR) with physical activity (PA) participation in overweight and obese populations, this relationship has not been examined among individuals seeking gastric bypass surgery (GBS). Furthermore, little is known about the specific intensity of activities undertaken by GBS candidates. Therefore, this study sought to determine whether greater PAR was associated with greater moderate-vigorous physical activity (MVPA) participation among GBS candidates. METHODS: The International Physical Activity Questionnaire (IPAQ), administered 2-weeks presurgery to 87 GBS candidates, determined MVPA participation using a formula based on metabolic equivalents (MET)-minutes/week. A stages-of-change measure categorized each candidate into one of five PAR stages: precontemplation, contemplation, preparation, action, or maintenance. RESULTS: The proportion of individuals in each PAR stage and the corresponding MVPA was as follows: contemplation (5.7%, 48.0 MET-minutes/week), preparation (46%, 394.0 MET-minutes/week), action (34.5%, 1614.0 MET-minutes/week), and maintenance (13.8%, 2056.7 MET-minutes/week). MVPA was significantly greater in candidates in the action or maintenance stages compared with those in contemplation (P =.008 and .025 for action and maintenance, respectively) or preparation (P < .0001 and .006 for action and maintenance, respectively). CONCLUSIONS: This study is the first to demonstrate a relationship between PAR and PA among GBS candidates, with 100% of the sample reporting either an intention to engage in PA or actual engagement in PA. This finding, coupled with the recent support for the importance of PA for weight loss/maintenance in GBS patients, warrants an investigation into the effectiveness of presurgical and postsurgical PA interventions matched to patients' PAR levels.

Adult↗

PubMed2006

The long-term effects of gastric bypass on vitamin D metabolism.

OBJECTIVE: Alterations of the endocrine system in patients following Roux-en-Y gastric bypass (GBP) are poorly described and have prompted us to perform a longitudinal study of the effects of GBP on serum calcium, 25-hydroxy-vitamin-D (vitamin D), and parathyroid hormone (PTH). METHODS: Prospectively collected data were compiled to determine how GBP affects serum calcium, vitamin D, and PTH. Student t test, Fisher exact test, or linear regression was used to determine significance. RESULTS: Calcium, vitamin D, and PTH levels were drawn on 243 patients following GBP. Forty-one patients had long-limb bypass (LL-GBP), Roux >100 cm, and 202 had short-limb bypass (SL-GBP), Roux < or =100 cm. The mean (+/-SD) postoperative follow-up time was significantly longer in the LL-GBP group (5.7 +/- 2.5 years) than the SL-GBP group (3.1 +/- 3.6 years, P < 0.0001). When corrected for albumin levels, mean calcium was 9.3 mg/dL (range, 8.5-10.8 mg/dL), and no difference existed between LL-GBP and SL-GBP patients. For patients with low vitamin D levels (<8.9 ng/mL), 88.9% had elevated PTH (>65 pg/mL) and 58.0% of patients with normal vitamin D levels (> or =8.9 ng/mL) had elevated PTH (P < 0.0001). In individuals with vitamin D levels <30 ng/mL, 55.1% (n = 103) had elevated PTH, and of those with vitamin D levels > or =30 ng/mL 28.5% (n = 16) had elevated PTH (P = 0.0007). Mean vitamin D levels were lower in patients who had undergone LL-GBP as opposed to those with SL-GBP, 16.8 +/- 10.8 ng/mL versus 22.7 +/- 11.1 ng/mL (P = 0.0022), and PTH was significantly higher in patients who had a LL-GBP (113.5 +/- 88.0 pg/mL versus 74.5 +/- 52.7 pg/mL, P = 0.0002). There was a linear decrease in vitamin D (P = 0.005) coupled with a linear increase in PTH (P < 0.0001) the longer patients were followed after GBP. Alkaline phosphatase levels were elevated in 40.3% of patients and correlated with PTH levels. CONCLUSION: Vitamin D deficiency and elevated PTH are common following GBP and progress over time. There is a significant incidence of secondary hyperparathyroidism in short-limb GBP patients, even those with vitamin D levels > or =30 ng/mL, suggesting selective Ca malabsorption. Thus, calcium malabsorption is inherent to gastric bypass. Careful calcium and vitamin D supplementation and long-term screening are necessary to prevent deficiencies and the sequelae of secondary hyperparathyroidism.

Adult↗

PubMed2006

Roux-en-Y gastric bypass surgery for morbid obesity: evaluation of postoperative extraluminal leaks with upper gastrointestinal series.

PURPOSE: To retrospectively evaluate the radiographic features of extraluminal leak after Roux-en-Y gastric bypass (RYGBP) surgery at upper gastrointestinal (GI) examinations in a large series of patients and to determine morbidity and mortality in those patients with leak. MATERIALS AND METHODS: The investigational review board approved this HIPAA-compliant study, and the need for patient informed consent was waived. Radiologic database review revealed 1202 upper GI studies performed over a 4-year period in 906 patients after RYGBP. Extraluminal leak was identified in 50 patients. Two patients with leaks that occurred before the study period were excluded. Of the remaining 48 patients, 12 were men and 36 were women (mean age, 45 years; range, 26-64 years). Surgery had been laparoscopic in 23 patients and open in 25. Upper GI studies were analyzed by two radiologists in consensus for the origin, extent, and severity of leaks and associated findings. Chart review was performed to determine clinical course, treatment, and outcome. RESULTS: Fifty extraluminal leaks were detected in 48 of 904 patients (5.3%) at upper GI examinations. All leaks were identified within 28 days, and, in 37 of 48 patients (77%), leakage was diagnosed within 1 week of surgery. The majority of leaks (n = 37) originated from the gastrojejunal anastomosis. Leaks also occurred at the distal portion of the esophagus (n = 5), the gastric pouch (n = 5), the oversewn jejunum (n = 2), and the distal anastomosis (n = 1). Leaks extended into the left upper quadrant in 30 patients. Obstruction or ileus was present in 35 of 48 patients (73%). Leak into the excluded stomach was observed in 15 of 48 patients. The occurrence of extraluminal leak prolonged hospital stays; organ failure occurred in 14 (29%) and death in three (6%) of the 48 patients. CONCLUSION: Extraluminal leak was identified on upper GI series in 48 of 904 patients (5.3%) after RYGBP for morbid obesity. Extraluminal leak most commonly arises from the gastrojejunal anastomosis and extends into the left upper quadrant. Extraluminal leak affects morbidity and mortality.

Adult↗

PubMed2006

Adolescent bariatric surgery: treatment delayed, treatment denied, a crisis invited.

Adolescent obesity has serious immediate and long-term health consequences. There are no effective behavioral or pharmacologic treatments of extreme obesity among adolescents. Bariatric surgery is the most effective means to achieve durable weight loss, with amelioration or resolution of most obesity-related co-morbidities. Surgery should be performed when: 1) the risk of operative complications and of recidivism is lowest; 2) the outcomes of the operation are likely to be the best possible; and 3) there is little need to consider subsequent bariatric surgery for weight regain and reappearance of co-morbidities. A higher BMI is an independent risk factor for operative morbidity and mortality, and is associated with less weight loss and greater likelihood of weight regain. The higher BMI criterion for adolescent bariatric surgery exposes the adolescent to a higher risk for operative death and complications, and suboptimal outcomes following bariatric surgery.

Adolescent↗

PubMed2005

Impact of major co-morbidities on mortality and complications after gastric bypass.

BACKGROUND: We hypothesized that major co-morbidities affect survival and complications after gastric bypass. METHODS: A total of 1465 patients undergoing laparoscopic and open gastric bypass between 1995 and 2002 were studied. Patients with a body mass index >or= 35 kg/m(2) and major co-morbidities (group 1, n = 1045) were compared with patients with a body mass index >or= 40 kg/m(2) with minor/no co-morbidities (group 2, n = 420). RESULTS: Group 1 patients were older (43 versus 36 years, P < 0.001) and had a greater BMI (53 versus 50 kg/m(2), P < 0.001). Early postoperative complications were greater in group 1 than in group 2 and included leaks (4.1% versus 1.2%, P < 0.0032) and wound infections (3.9% versus 1.4%, P < 0.0133). Procedure-related mortality in the series was 1.7%. Mortality was 10-fold greater in group 1 (2.3% versus 0.2%, P < 0.0032). The incidence of small bowel obstruction, incisional hernia, and pulmonary embolism was similar in the two groups. Excess weight loss was significantly greater in group 2 (68% versus 62%, P < 0.001) at 1 year. Resolution of group 1 co-morbidities was great, including hypertension in 62%, diabetes in 75%, venous stasis disease in 96%, and pseudotumor cerebri in 98%. CONCLUSION: Outcomes analysis of obesity surgery requires risk stratification. The very low mortality rates in published studies are likely explained by surgical treatment of low-risk patients with minor co-morbidities, such as those seen in group 2. However, despite the increased perioperative risk, the group 1 patients (with major co-morbidities) demonstrated dramatic resolution of their co-morbid conditions, justifying the decision to go forward with surgery. The data support a radical change in treatment philosophy in which morbidly obese individuals should be offered bariatric surgery before major co-morbid conditions develop as a strategy to decrease the operative risk.

Adult↗

PubMed2005

Internal hernia after laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Internal hernia (IH) is a technical complication of laparoscopic Roux-en-Y gastric bypass (LRYGBP) that can have severe consequences. Little has been written on characterizing this complication. Antecolic Roux limb passage has been suggested to be safe without defect closure. METHODS: The records of 785 patients who underwent LRYGBP (136 antecolic, 649 retrocolic) between 1998 and 2003 were reviewed. In our early experience (n = 107), we used a retrocolic technique without defect closure. RESULTS: Twenty patients underwent surgical intervention for IH. The median interval between LRYGBP and symptom onset was 303 days (range, 25 to 1642 days). Abdominal pain was uniformly present, and 63% of patients developed nausea and/or vomiting. Exploratory laparoscopy was attempted in 94% of patients; conversion was necessary in 33%. A total of 21 IHs were identified (13 Petersen's, 5 mesocolic, 2 jejunojejunal, and 1 adhesion-related hernia). No nonviable bowel was identified, and no deaths occurred. A retrocolic technique involving closure of all defects resulted in the lowest rate of hernias (3/542; 0.55%) compared with the antecolic (12/136; 8.81%; P < .0001) and early retrocolic techniques (6/107; 5.6%; P < .0002). CONCLUSION: IH can occur long after gastric bypass surgery, and a low threshold for reoperation is crucial to avoid gut infarction. A retrocolic technique with defect closure appears to afford the lowest risk of IH. The lower incidence of IH in other series after antecolic technique likely results from a less aggressive detection and management approach, because our nonclosure technique could not differ from that of other authors. All defects must be closed to minimize the risk of hernia, whether antecolic or retrocolic.

Adult↗

PubMed2005

Poor outcomes in cirrhosis-associated hernia repair: a nationwide cohort study of 32,033 patients.

Cirrhosis is a significant marker of adverse postoperative outcome. A large national database was analyzed for abdominal wall hernia repair outcomes in cirrhotic vs. non-cirrhotic patients. Data from cirrhotics and non-cirrhotics undergoing inpatient repair of abdominal wall hernias (excluding inguinal) from 1999 to 2004 were obtained from the University HealthSystem Consortium (UHC) database. Differences (P < 0.05) were determined using standard statistical methods. Inpatient hernia repair was performed in 30,836 non-cirrhotic (41.5% male) and 1,197 cirrhotic patients (62.7% male; P < 0.0001). Cirrhotics had a higher age distribution (P < 0.0001), no race differences (P = 0.64), underwent ICU admission more commonly (15.9% vs. 6%; P < 0.0001), had a longer LOS (5.4 vs. 3.7 days), and higher morbidity (16.5% vs. 13.8%; P = 0.008), and mortality (2.5% vs. 0.2%; P < 0.0001) compared to non-cirrhotics. Several comorbidities had a higher associated mortality in cirrhosis: functional impairment, congestive heart failure, renal failure, nutritional deficiencies, and peripheral vascular disease. The complications with the highest associated mortality in cirrhotics were aspiration pneumonia, pulmonary compromise, myocardial infarction, pneumonia, and metabolic derangements. Cirrhotics underwent emergent surgery more commonly than non-cirrhotics (58.9% vs. 29.5%; P < 0.0001), with longer LOS regardless of elective or emergent surgery. Although elective surgical morbidity in cirrhotics was no different from non-cirrhotics (15.6% vs. 13.5%; P = 0.18), emergent surgery morbidity was (17.3% vs. 14.5%; P = 0.04). While differences in elective surgical mortality in cirrhotics approached significance (0.6% vs. 0.1%; P = 0.06), mortality was 7-fold higher in emergencies (3.8% vs. 0.5%; P < 0.0001). Patients with cirrhosis carry a significant risk of adverse outcome after abdominal wall hernia repair compared to non-cirrhotics, particularly with emergent surgery. It may, however, be safer than previously thought. Ideally, patients with cirrhosis should undergo elective hernia repair after medical optimization.

Adolescent↗

PubMed2005

Laparoscopic adjustable gastric banding: evolving clinical experience.

Laparoscopic adjustable gastric banding (LAGB) was first introduced in the early 1990s as a potentially safe, controllable, and reversible method for achieving significant weight loss in the severely obese. It is timely to review the existing data on this procedure derived from European, Australian, and American studies and compare and contrast their results. Special emphasis is placed on clinical outcomes and reported complications of LAGB. In general, international studies support use of the LAGB procedure,while American studies are generally better designed but more equivocal in their results.

Body Mass Index↗

PubMed2005

Perioperative management of special populations: obesity.

Surgeons and hospitals must be aware of the special considerations for treating obese patients. Obesity involves increased incidence of several comorbidities, such as coronary heart disease and hyper-tension, which increase perioperative risk. Obesity has been identified as an independent risk factor for surgical site infection and the obese population has a higher than normal incidence of perioperative deep venous thrombosis and pulmonary embolism. For these and other reasons, medical professionals must make thorough evaluations to properly identify and address medical comorbidities and other issues associated with obese patients. Medical professionals must, for example, use invasive arterial monitoring for severely obese patients and ensure that operating room tables can accommodate obese patients.

Body Mass Index↗

PubMed2005

The optimal surgical management of the super-obese patient: the debate. Presented at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, Hollywood, Florida, USA, April 13-16, 2005.

Optimal management of the super-obese patient (body mass index>50 kg/m2) undergoing weight loss surgery in the new era of laparoscopic treatment is more controversial than ever before. Newer laparoscopic options for treatment of the super obese, including laparoscopic adjustable gastric banding, sleeve gastrectomy, and staging of gastric bypass, are technically easier and may be safer. Concerns that weight loss may be suboptimal or that the procedures will require revision, or both, make these choices controversial. Open access/conversion for established procedures such as long-limb gastric bypass and biliopancreatic diversion with or without duodenal switch are the traditional alternatives when laparoscopic access fails or is deemed too difficult to undertake. The following debate was presented by invited experts in laparoscopic and open bariatric surgery at the 2005 Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons in Florida. The presenters put forth arguments for the various modern options for treatment of the super obese, which are presented in written form. Interactive audience response technology provided a mechanism for polling the audience before and after the presentations. A review of the audience's responses provides insight into the decision-making considerations of a population of laparoscopically oriented bariatric surgeons.

Anastomosis, Roux-en-Y↗

PubMed2005

Night call does not impair learning of laparoscopic skills.

Investigators have looked at the effect of night call on surgical residents but not at learning of laparoscopic skills. The Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) tests 6 tasks similar to a laparoscopic cholecystectomy. We hypothesized that night call would impair laparoscopic performance and that skills would not improve but rather deteriorate after night call. Seventeen volunteers were tested before and after night call. Data collected included economy of movement, time, and number of errors for each hand/foot. A paired Student t test was used for statistical analysis. On the first 2 tasks, there was an improvement in all parameters post-call, with significance reached in 5 of 18 parameters (P<or=.05). In the "running of the bowel,'' 8 of 9 parameters were significantly improved (P<or=.05). In the final task, 9 of 11 parameters showed a deterioration post-call, but only economy of movement of the foot was significant (P<or=.05). Most parameters (16) showed improvement rather than deterioration post-call, which is consistent with learning of laparoscopic skills despite lack of sleep from night call.

Educational Measurement↗

PubMed2005

Onlay hiatal reinforcement utilizing human acellular dermal matrix: three case series.

Redo laparoscopic fundoplication and laparoscopic repair of large (>5cm) paraesophageal hernias have a high rate of recurrence after primary suture repair of the hiatal defect. As such, the use of mesh prosthesis as an interposition graft or onlay reinforcement is becoming more popular for the repair of larger, more complicated crural defects. We report three cases in which human acellular dermal matrix was used as an onlay reinforcement of the hiatus after primary suture closure. Two patients had large paraesophageal hernias (one type III and one type IV). The third patient became symptomatic after her second laparoscopic antireflux procedure and was found to have recurrent herniation of the fundus into the mediastinum. All three patients underwent successful laparoscopic repair. There were no intraoperative or postoperative complications. All three patients remain symptom free with follow-up ranging from 8 months to 10 months. Acellular dermal matrix appears to be a promising prosthetic for onlay reinforcement of the hiatus during redo laparoscopic fundoplication and repair of large paraesophageal hernias.

Aged↗

PubMed2005

Per-oral circular stapler in laparoscopic Roux-en-Y gastric bypass.

Circular staplers are used to create the gastrojejunostomy of the Roux-en-Y gastric bypass. The anvil of the stapler can be placed within the pouch by way of the oropharynx or trans-abdominally, but these methods have limitations. The SurgASSIST Computer Mediated Stapler (Power Medical Interventions, New Hope, PA, USA) is a new technology that changes surgical stapling. The staplers are closed and fired under surgeon control by a computer for better accuracy and reliability. It has a 21-mm stapler, which can be passed orally for endoluminal stapling. The SurgASSIST has several advantages over the traditional circular stapled gastrojejunal anastomosis, including no need to dilate trocars to accommodate the stapler through the abdominal wall and decreased wound infections.

Gastric Bypass↗

PubMed2004

Laparoscopic Roux-en-Y gastric bypass in a patient with intestinal malrotation.

A morbidly obese female with a body mass index of 50.7 kg/m2 and comorbidities of back pain and migraine headaches was taken to the operating room for a laparoscopic Roux-en-Y gastric bypass. She was incidentally found to have intestinal malrotation. The Roux-en-Y gastric bypass was completed laparoscopically, followed by laparoscopic division of Ladd's bands, and appendectomy.

Adult↗

PubMed2004

Effects of bariatric surgery in older patients.

OBJECTIVE: Evaluate the safety and efficacy of bariatric surgery in older patients. BACKGROUND: Because of an increased morbidity in older patients who may not be as active as younger individuals, there remain concerns that they may not tolerate the operation well or lose adequate amounts of weight. METHODS: The database of patients who had undergone bariatric surgery since 1980 and National Death Index were queried for patients <60 and >/= 60 years of age. GBP was the procedure of choice after 1985. Data evaluated at 1 and 5 years included weight lost, % weight lost (%WL), % excess weight loss (%EWL), % ideal body weight (%IBW), mortality, complications, and obesity comorbidity. RESULTS: Eighty patients underwent bariatric surgery: age 63 +/- 3 years, 78% women, 68 white, 132 +/- 22 kg, BMI 49 +/- 7 kg/m, 217 +/- 32%IBW. Preoperative comorbidity, was greater (P < 0.001) in patients >/= 60 years. There were no operative deaths but 11 late deaths. COMPLICATIONS: 4 major wound infections, 2 anastomotic leaks, 10 symptomatic marginal ulcers, 5 stomal stenoses, 3 bowel obstructions, 26 incisional hernias (nonlaparoscopic), and 1 pulmonary embolism. At 1 year after surgery (94% follow-up), patients lost 38 +/- 11 kg, 57%EWL, 30%WL, BMI 34.5 +/- 7 kg/m, %IBW 153 +/- 31. Comorbidities decreased (P < 0.001); however, %WL and %EWL and improvement in hypertension and orthopedic problems, although significant, were greater in younger patients. At 5 years after surgery (58% follow-up), they had lost 31 +/- 18 kg, 50%EWL, 26%WL, BMI 35 +/- 8 kg/m, and %IBW 156 +/- 36. CONCLUSIONS: Bariatric surgery was effective for older patients with a low morbidity and mortality. Older patients had more pre- and post-operative comorbidities and lost less weight than younger patients. However the weight loss and improvement in comorbidities in older patients were clinically significant.

Age Factors↗

PubMed2004

Normal anatomy and complications after gastric bypass surgery: helical CT findings.

PURPOSE: To determine the usefulness and potential pitfalls of helical computed tomography (CT) for depiction of normal anatomy and diagnosis of complications after gastric bypass surgery. MATERIALS AND METHODS: From March 1998 to July 2002, 100 abdominal and pelvic CT examinations were performed in 72 patients after gastric bypass surgery for treatment of morbid obesity. Two of four attending abdominal radiologists retrospectively assessed the CT images in consensus for normal postoperative gastrointestinal anatomy and complications such as leaks, staple line dehiscence, bowel obstruction, abscess, hepatic or splenic infarction, and hernia. CT findings were compared with clinical, surgical, and other imaging findings. RESULTS: The gastric pouch, excluded stomach, proximal efferent loop, oversewn jejunal loop, and distal jejunojejunal anastomosis were identified in 96 (96%) of 100 studies and 69 (96%) of 72 patients, 100 (100%) of 100 studies and 72 (100%) of 72 patients, 99 (99%) of 100 studies and 71 (99%) of 72 patients, 88 (88%) of 100 studies and 61 (85%) of 72 patients, and 67 (67%) of 100 studies and 46 (64%) of 72 patients, respectively. The fundus of the excluded stomach was filled with a combination of air, fluid, and contrast material, which mimicked a loculated fluid collection in 15 (15%) of 100 studies and 13 (18%) of 72 patients. Sixty-two abnormalities, detected in 41 patients, included leak (n = 12), loculated fluid collection unrelated to leak (n = 9), markedly distended excluded stomach (n = 6), small-bowel obstruction (n = 6), gastric staple line dehiscence (n = 6), splenic infarction (n = 5), hematoma (n = 5), left hepatic lobe infarction (n = 3), and hernia related to gastric bypass (n = 10, including three internal hernias, three incisional hernias, and four nonincisional ventral hernias). Seventeen patients required a total of 21 CT-guided interventional procedures. CONCLUSION: Helical CT is useful for identifying normal postoperative anatomy and complications after gastric bypass surgery.

Adolescent↗