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CTisus CT Scanning CTisus CT Scanning CTisus CT Scanning CTisus CT Scanning CTisus CT Scanning CTisus CT Scanning CTisus CT Scanning CTisus CT Scanning CTisus CT Scanning Ask the Fish

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


  • Background

    What is Laparoscopic Sleeve Gastrectomy?

    • Minimally invasive partial resection of the stomach along the greater curvature to create a sleeve or tubular morphology.
    • Weight loss results due to restrictive and endocrine mechanisms

    Indications

    • Morbid obesity BMI >40
      • Stand-alone treatment
      • High-risk patients
      • Kidney and liver transplant candidates
      • Metabolic syndrome
      • BMI 30-35 with comorbidities

    Contraindications

    • Barrett’s esophagus
      • Some consider it an absolute contraindication due to future need for gastric-pull surgery with cancer.
    • GERD (relative)
    • Prohibitive anesthesia risk
    • Uncontrolled psychiatric illness
    • Coagulopathy
  • Operative Procedure

    Laparoscopic

    • Identify pylorus
    • Mobilize greater curvature and ligate gastroepiploic and short gastric vasculature
    • Assess hiatus for hernia
    • Insert Bougie
    • Transect stomach beginning 3-6 cm proximal to the pylorus
    • Extract specimen

    Advantages

    • No enteric anastomosis
    • No risk of internal hernia, dumping syndrome, or marginal hernia
    • Decreases ghrelin
    • Maintains access to pancreaticobiliary system
    • Similar effect on weight loss
    • Technically simpler
  • Normal Post Operative Appearance

    What is Laparoscopic Sleeve Gastrectomy? CT Case Study 1 CT Case Study 2 Medical Illustration

    • Minimally invasive partial resection of the stomach along the greater curvature to create a sleeve or tubular morphology.
    • Weight loss results due to restrictive and endocrine mechanisms
  • Complications

    Overall rate is less than gastric bypass


    Leak- most common CT Case Study

    • More susceptible to a leak than RYGB (2.4 versus 0.7%)
    • Most often occurs at the proximal end
    • Majority occur more than 10 days postop
    • Imaging
      • Contrast extravasation or opacification of a drain
      • Free air or air fluid level adjacent to site of leak
      • Staple line gap
      • Phlegmon or abscess

    Fistula CT Case Study

    • Gastrocutaneous, gastrocolic, and gastrobronchial
    • Imaging
      • Contrast connection
      • Fluid collection or abscess, effusion

    Bleeding CT Case Study Medical Illustration

    • Staple line, splenic Injury
    • Imaging
      • Fluid collection with high-density content or fluid-fluid level
      • Contrast extravasation

    Stricture CT Case Study Medical Illustration

    • Acute or chronic
    • Often occurs at incisura angularis
    • Imaging- use MPRs
      • Dilated proximal stomach and esophagus
      • Luminal narrowing of stomach
      • Contrast stasis proximally
      • Angulation of stomach at stenosis

    Portal Vein Thrombosis

    • Rare

    Splenic infarct- rare

    • Related to ligation of short gastric vessels to mobilize fundus
    • Imaging
      • Wedge shaped peripheral area of hypodensity

    Redundant gastric remnant


    GERD

    • Imaging
      • Reflux of oral contrast
      • Hiatal hernia
      • Distended esophagus

    Wound complications and trocar site hernia

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