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This Article Figures Only Full Text All Versions of this Article: 2482070926v1 248/2/504    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Carucci, L. R. Articles by Turner, M. A. PubMed PubMed Citation Articles by Carucci, L. R. Articles by Turner, M. A.

Roux-en-Y Gastric Bypass Surgery for Morbid Obesity: Evaluation of Leak into Excluded Stomach with Upper Gastrointestinal Examination¹

¹ From the Department of Radiology, Virginia Commonwealth University Medical Center, 1250 E Marshall St, Main Hospital, 3rd Floor, Rm 417, PO Box 980615, Richmond, VA 23298-0615. Received May 30, 2007; revision requested August 2; revision received September 30; accepted January 7, 2008; final version accepted February 19. Address correspondence to L.R.C. (e-mail: lcarucci@vcu.edu).

Purpose: To retrospectively evaluate the imaging features at upper gastrointestinal (GI) examination of leak into the excluded part of the stomach after the Roux-en-Y gastric bypass (RYGB) procedure and to determine the associated complications and consequences of acute versus delayed leak development.

Materials and Methods: The institutional review board approved this HIPAA-compliant study; the need for informed consent was waived. Database review revealed 1655 upper GI studies performed over 6 years in 1282 patients after an RYGB procedure. Leak into the excluded stomach was diagnosed in 48 patients (39 women, nine men; age range, 29–62 years; mean age, 46 years); these patients formed our study group. Studies were analyzed by two radiologists in consensus for extent and pattern of leak into the excluded stomach and the presence of associated complications of extraluminal leak or fistula, obstruction, and acute distention of the excluded stomach. Chart review was performed to determine clinical course, treatment, associated complications, and outcome. Patients were divided into two categories on the basis of acute versus delayed development of leak into the excluded stomach. Acute leak into the excluded stomach was diagnosed within 2 months of surgery. Delayed leak occurred more than 2 months after surgery.

Results: Leak into the excluded stomach occurred in the acute postoperative period (within 2 months) in 25 of the 48 patients (52%) and was associated with extraluminal leak in 22 of those 25 patients (88%). Acute leak into the excluded stomach healed in seven of the 25 patients (28%). Delayed postoperative leak into the excluded stomach occurred in 23 of the 48 patients (48%) and resulted in failed weight loss in 14 of those 23 patients (61%). Fourteen of the 48 patients (29%) underwent surgical revision for leak into the excluded stomach.

Conclusion: Leak into the excluded stomach was identified on upper GI studies in 48 of 1282 patients (3.7%) after RYGB for morbid obesity. Acute leak into the excluded stomach may heal spontaneously; however, remote postoperative leak into the excluded stomach can result in failed weight loss and subsequent failure of the RYGB procedure.

© RSNA, 2008