Purpose: To describe the various complications following bariatric Roux—en—Y gastric bypass surgery and to determine the role of radiologic imaging.
Methods and Materials: Between March 1998 and December 2002, a total of 335 consecutive patients underwent bariatric Roux—en—Y gastric bypass in a single teaching hospital. Standard post—procedure imaging consisted of an upper GI study within the first 48 hours post—surgery. Additional imaging studies were performed as requested by the operating surgeon depending on the clinical findings. The follow—up period ranged from three months to five years. All post—procedure imaging studies as well as the type and onset of each complication were recorded in this retrospective study.
Results: Complications were as follows: death occurred in two patients (0.6%), anastomotic leak in eight patients (2.4%), staple line disruption in five patients (1.5%), pulmonary embolism in three patients (0.9%), bleeding in four patients (1.2%), pneumonia in two patients (0.6%), bowel obstruction with 30 days in five patients (1.5%), anastomotic stenosis in six patients (1.8%), sepsis in one patient (0.3%), pouch ulcer in two patients (0.6%), wound dehiscence in one patient (0.3%), esophageal injury in one patient (0.3%), and readmission within 30 days for various reasons in 17 patients (5.1%). The overall complication rate of 57/335 (17.1%) grossly overestimated the actual rate as most of the readmitted patients had a complication listed in the other categories. Radiologic imaging studies were performed in more than 90% of all patients with complications following bariatric surgery.
Conclusion: Severely obese patients are considered to be high-risk because of their comorbidities. In addition, there is a wide spectrum of complications following bariatric Roux—en—Y gastric bypass. As physical examination is very challenging in the majority of bariatric patients, radiology plays an important role in the management of these patients.