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Everything you need to know about Computed Tomography (CT) & CT Scanning


  • Background

    What is Laparoscopic Sleeve Gastrectomy?

    • Minimally invasive partial resection of the stomach along the greater curvature to create a sleeve or tubular morphology.
    • Weight loss results due to restrictive and endocrine mechanisms

    Indications

    • Morbid obesity BMI >40
      • Stand-alone treatment
      • High-risk patients
      • Kidney and liver transplant candidates
      • Metabolic syndrome
      • BMI 30-35 with comorbidities

    Contraindications

    • Barrett’s esophagus
      • Some consider it an absolute contraindication due to future need for gastric-pull surgery with cancer.
    • GERD (relative)
    • Prohibitive anesthesia risk
    • Uncontrolled psychiatric illness
    • Coagulopathy
  • Operative Procedure

    Laparoscopic

    • Identify pylorus
    • Mobilize greater curvature and ligate gastroepiploic and short gastric vasculature
    • Assess hiatus for hernia
    • Insert Bougie
    • Transect stomach beginning 3-6 cm proximal to the pylorus
    • Extract specimen

    Advantages

    • No enteric anastomosis
    • No risk of internal hernia, dumping syndrome, or marginal hernia
    • Decreases ghrelin
    • Maintains access to pancreaticobiliary system
    • Similar effect on weight loss
    • Technically simpler
  • Normal Post Operative Appearance

    What is Laparoscopic Sleeve Gastrectomy? CT Case Study 1 CT Case Study 2 Medical Illustration

    • Minimally invasive partial resection of the stomach along the greater curvature to create a sleeve or tubular morphology.
    • Weight loss results due to restrictive and endocrine mechanisms
  • Complications

    Overall rate is less than gastric bypass


    Leak- most common CT Case Study

    • More susceptible to a leak than RYGB (2.4 versus 0.7%)
    • Most often occurs at the proximal end
    • Majority occur more than 10 days postop
    • Imaging
      • Contrast extravasation or opacification of a drain
      • Free air or air fluid level adjacent to site of leak
      • Staple line gap
      • Phlegmon or abscess

    Fistula CT Case Study

    • Gastrocutaneous, gastrocolic, and gastrobronchial
    • Imaging
      • Contrast connection
      • Fluid collection or abscess, effusion

    Bleeding CT Case Study Medical Illustration

    • Staple line, splenic Injury
    • Imaging
      • Fluid collection with high-density content or fluid-fluid level
      • Contrast extravasation

    Stricture CT Case Study Medical Illustration

    • Acute or chronic
    • Often occurs at incisura angularis
    • Imaging- use MPRs
      • Dilated proximal stomach and esophagus
      • Luminal narrowing of stomach
      • Contrast stasis proximally
      • Angulation of stomach at stenosis

    Portal Vein Thrombosis

    • Rare

    Splenic infarct- rare

    • Related to ligation of short gastric vessels to mobilize fundus
    • Imaging
      • Wedge shaped peripheral area of hypodensity

    Redundant gastric remnant


    GERD

    • Imaging
      • Reflux of oral contrast
      • Hiatal hernia
      • Distended esophagus

    Wound complications and trocar site hernia

© 1999-2019 Elliot K. Fishman, MD, FACR. All rights reserved.