IBC-Oxford University2023_BJSOral_26A Novel Classification for Gastric Migration after Sleeve Gastrectomy and a Proposed Algorithm for its Management Based on CT 3D Reconstructions.

Abstract

Abstract Introduction Sleeve gastrectomy has become a primary bariatric procedure for obesity treatment, but it is associated with the development of hiatal hernias and gastric migration. This migration can lead to complications such as gastro-oesophageal reflux disease. The study aims to classify and analyse gastric migration patterns after sleeve gastrectomy using 3D reconstructed images and propose an algorithm for management. Methods A standardized protocol for assessing post-bariatric surgery anatomy was implemented at Clinica Portoazul, Colombia. CT with 3D reconstruction was performed on 100 patients who had undergone sleeve gastrectomy. Images were analysed for gastric migration, and cases were classified based on the extent and type of herniation. Results Out of 100 patients reviewed, 28 (34.1%) had hiatal hernias with varying degrees of gastric migration. Among these patients, 22 (26.8%) had Type 1 hernias (sliding with <1/3 gastric tube herniation), 2 (2.4%) had Type 2 hernias (>1/3 stomach herniated), and 4 (4.9%) had Type 3 hernias (paraesophageal migration). Discussion Gastric migration after sleeve gastrectomy is a rare complication with potential serious symptoms. Risk factors include history of hiatal hernia, severe obesity, large gastric pouch, and surgical errors. The proposed classification, based on 3D reconstructed images, provides insight into migration patterns and aids in planning revisional surgery. Conclusion Gastric migration after sleeve gastrectomy can be assessed using 3D reconstructed CT images. The proposed classification helps categorize migration types, informing treatment decisions. We used this classification to design an algorithm for gastric migration management after sleeve gastrectomy, considering the identified patterns. Further research is needed to validate the classification and determine its role in treatment planning.