Elsevier

Surgery for Obesity and Related Diseases

Volume 2, Issue 6, November–December 2006, Pages 651-655
Surgery for Obesity and Related Diseases

Original article
Percutaneous computed tomography-guided gastric remnant access after laparoscopic Roux-en-Y gastric bypass

Presented at the International Federation of Surgery for Obesity (IFSO) Meeting, Tokyo, Japan, September 8–11, 2004
https://doi.org/10.1016/j.soard.2006.09.007Get rights and content

Abstract

Background

The bypassed portion of the stomach is difficult to access and evaluate after Roux-en-Y gastric bypass. Access to the excluded stomach may be needed for nutritional support or decompression owing to acute distension and obstruction. We report our experience with percutaneous, computed tomography (CT)-guided gastrostomy tube placement into the gastric remnant after laparoscopic Roux-en-Y gastric bypass (LRYGB).

Methods

Of 569 consecutive LRYGB procedures performed, 9 patients underwent successful percutaneous, CT-guided gastrostomy placement. One additional patient was referred from another facility. We reviewed the indications, interval from surgery to the intervention, interval to removal, complications, and success or outcome of the procedure in our patient population.

Results

Ten patients underwent percutaneous, CT-guided gastric remnant gastrostomy tube placement. The indications included distended gastric remnant in 6, nutritional access in 4, and remnant drainage after leak in 1. Of the 10 patients, 2 had undergone previous gastric operations. The attempt at percutaneous gastrostomy was unsuccessful in 1 additional patient, who subsequently required laparoscopic gastrostomy (success rate 91%).

Conclusion

In selected patients after LRYGB, CT-guided gastrostomy tube placement is safe and efficient. It may be used to manage complications of LRYGB, serve as a bridge to definitive surgery, or offer a convenient route for enteral nutritional support.

Section snippets

Methods

In a retrospective analysis of a prospectively collected database our first 569 consecutive LRYGB cases performed between July 1999 and June 2004, we identified 10 patients who had undergone attempted percutaneous, CT-guided gastric remnant gastrostomy placement (1.6%). An additional patient was referred to our care from another facility. All gastrostomy tubes were placed by 2 interventional radiologists at our institution using a single-slice helical scanner (GE9800 Hispeed, General Electric,

Results

Of the 11 patients, 10 (91%) underwent successful percutaneous, CT-guided gastric remnant gastrostomy placement. The indications are summarized in Table 1. Of the 10 patients, 2 (20%) had undergone revisional bariatric procedures. One patient had undergone a previous open gastric bypass for morbid obesity and had then undergone laparoscopic revision of the Roux limb length for inadequate weight loss. The patient presented on postoperative day 10 with nausea and abdominal discomfort. CT

Discussion

The gastric remnant is a blind pouch of the foregut formed after gastric bypass surgery that is difficult to access by standard techniques. Pathologic findings in the bypassed stomach include leak [7], acute dilation [8], bleeding [10], and ulcer formation [11]. Treatment and evaluation of these complications may warrant access by way of a gastrostomy tube.

In 2 related reports, Fobi et al. [9], [12] described routine placement of a gastrostomy tube, with a radiopaque silastic ring around it, at

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Supported in part by a research grant from Tyco/United States Surgical Corporation

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