Value of Multi-Slice Computed Tomography in The Evaluation of Postoperative Complications After Laparoscopic Sleeve Gastrectomy

Abstract

Background: Obesity is a medical condition that have an adverse effect on health. Bariatric surgery is considered nowadays as one of the most effective treatment for obesity. CT is one of the best modalities that is performed after a bariatric procedure to assess for complications. Purpose: The aim of this work was to highlight CT radiological features of postoperative surgical complications after laparoscopic sleeve gastrectomy (LSG) using abdominal multi-slice computed tomography (MSCT), and 3D volumetric rendering if needed. Patients and Methods: 182 patients with post sleeve gastrectomy suspected complications were subjected to CT of the abdomen and pelvis. Post-processing was performed with multi-planner reformation generating coronal and sagittal images together with the raw axial images for assessment of the integrity of the sleeved stomach and detection of any encountered complication with 3D reconstruction if needed to asses gastric pouch volume. Results: CT detected complications in 43 patients (23.6%) out of the 182 patients who underwent laparoscopic sleeve gastrectomy. The complications reported in our study were hematoma occurred in 13 patients (7.1%), leakage occurred in 10 patients (5.5%), abscess formation occurred in 6 cases (3.3%), splenic infarction occurred in 5 patients (2.7%), solid organ injury occurred in 2 patient (1%), Porto-mesenteric thrombosis occurred in 7 patients (3.8%), intestinal obstruction occurred in 2 cases (1%), port site ventral hernia occurred in 3 cases (1.6%), abdominal wall hematoma occurred in 3 cases (1.6%), enlarged gastric pouch occurred in 4 cases (2.2%), hiatus hernia occurred in 2 cases (1%). Conclusion: It could be concluded that sleeve gastrectomy became an increasingly popular surgery for obesity, so the radiologists must recognize and identify the normal postoperative anatomy as well as the possible complications of this procedure. MSCT with the 3D volumetric study is an important imaging tool to diagnose accurately the complications of sleeve gastrectomy.