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


  • Background

    What is Roux-en-Y Gastric Bypass?

    • Most common bariatric surgery, most often performed laparoscopically.
    • Division of the stomach by stapling into a small pouch and attaching this pouch directly to the jejunum, Roux limb.
    • Weight loss is due to restriction and malabsorption.

    Indications

    • Morbid obesity with BMI >40 kg/m2
    • Morbid obesity with BMI 35-39.9 kg/m2 with at least one serious comorbidity such as : Type 2 Diabetes, Hypertension, Hyperlipidemia, NASH, NAFLD, OSA, ....
    • Morbid obesity with BMI 30-34.9 kg/m2 AND Uncontrolled type 2 or Metabolic Syndrome

    Contraindications

    • Crohn's disease
    • Chronic glucocorticoid or nonsteroidal anti-inflammatory use
    • Uncontrolled psychiatric illness
    • Coagulopathy
  • Operative Procedure

    Laparoscopic

    • Division of the falciform ligament
    • Creation of retrocolic or antecolic passageway of the Roux limb
    • Jejunojejunal (JJ) anastomosis
    • Creation of gastric pouch
    • Gastrojejunal (GJ) anastomosis
    • Intraoperative leak test
    • Closure of the potential hernia sites
    • Drain placement

    Considerations

    • Bypass length
    • Antecolic vs retrocolic passage of the Roux limb

    Advantages

    • Similar to sleeve gastrectomy in terms of weight loss.
    • Better suited for patients with GERD or Barret's esophagus
  • Normal Post Operative Appearance

    What is Roux-en-Y Gastric Bypass? CT Case Study 1 CT Case Study 2 Medical Illustration

    • Most common bariatric surgery, most often performed laparoscopically.
    • Division of the stomach by stapling into a small pouch and attaching this pouch directly to the jejunum, Roux limb.
    • Weight loss is due to restriction and malabsorption.
  • Complications

    Dumping Syndrome

    • Most common complication up to 50%
    • Post prandial flushing, diaphoresis, palpitations, and diarrhea.

    Anastomotic Stenosis

    • 6-20 % develop stromal stenosis(less than 10 mm in diameter) at the anastomosis site several weeks post-op.

    Marginal Ulcers CT Case Study 1 CT Case Study 2 Medical Illustration

    • 1-16 % develop marginal ulcers near the gastrojejunostomy due to gastric acid injuring the jejunal mucosa.
    • Other causes include gastrogastric fistula, ischemia at anastomosis, foreign material such as staples, NSAIDs use, or H-Pylori.

    Internal Hernia Medical Illustration

    • Less than 5%

    Cecal Volvulus CT Case Study

    • Cecal volvulus is an uncommon complication, with a few cases reported in the liturature.

    Small Bowel Obstruction CT Case Study 1 CT Case Study 2 Medical Illustration

    • Less than 5%

    Leak

    • Less risk than gastric sleeve (2.4 versus 0.7%)

    Gastrogastric fistula CT Case Study 1 CT Case Study 2 Medical Illustration

    • 1-2 %
    • Associated with marginal ulcer and weight regain.

    Gastric remnant distention

    • Rare but potentially lethal due to rupture.

    Candy cane Roux syndrome

    • Patients present with postprandial pain relieved by vomiting
    • The afferent loop is distended with food, relieved when it empties into the Roux limb or vomited out

    Other: short bowel syndrome, cholelithiasis, nephrolithiasis, incisional hernias

© 1999-2018 Elliot K. Fishman, MD, FACR. All rights reserved.