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