3D CAT Scan and Gastric Volumetry in the Planning of Revisional Bariatric Surgery

The planning of revisional bariatric surgery is a complex process. The availability of accurate anatomical information is especially important for the planning of such challenging surgical procedures, we present our initial experience using three-dimensional-computed tomography (3D-CT) images to preoperatively assess the anatomy of patients before bariatric revisional surgery.

We used 3D reconstructed images of CT scans to assess the anatomy and plan revisional surgery in 144 patients 98 of them had a previous sleeve gastrectomy 41 had a previous gastric by-pass and 4 Vertical banded gastroplasties. An effervescent preparation was used to distend the stomach and the proximal bowel allowing volume estimation.

Eleven sleeve patients underwent a re-sleeve gastrectomy and 44 were revised to a "Roux-en-Y" gastric bypass (RYGBP). Forty-two patients with a previous gastric by-pass were revised due to weight regain or other issues and 4 patients with previous vertical banded gastroplasty (VBGP) were revised to RYGBP. 3D-CT scans provided valuable information for the planning of all revisional procedures by offering accurate information about the existing anatomy and measures of the volume of the gastric pouch, the size of the gastro-jejunal anastomosis in gastric by-pass cases, or the volume and shape of the gastric tube in gastric sleeve cases.

3D-CT is a fast, widely available, reliable, and accurate tool to assess the anatomy after bariatric procedures. This noninvasive method can be particularly useful for the evaluation of postbariatric patients with failures, suboptimal results, and complications, and for the planning of revisional surgery.