Computed tomography roadmap for post-operative fundoplication imaging with a novel structured reporting checklist.

Area of Science:

• Gastroenterology
• Surgical Innovation
• Medical Imaging

Background:

• Laparoscopic anti-reflux surgery (LARS) is increasingly common, leading to intermittent fundoplication wrap complications like heartburn and dysphagia.
• Endoscopy and barium swallow are traditional but less favored methods for diagnosing wrap failures.
• Multislice computed tomography (CT) offers advanced imaging capabilities for evaluating these failures.

Purpose of the Study:

• To establish a standardized CT reporting format for fundoplication wrap failures.
• To improve the diagnostic accuracy and management of post-LARS complications.
• To facilitate uniformity in reporting and aid in creating registries for wrap failures.

Main Methods:

• A literature review on CT use for fundoplication wrap failure.
• Formation of a multidisciplinary team of radiologists and surgeons.
• Pilot study of 43 patients with wrap failure using multislice CT and a novel structured reporting checklist.

Main Results:

• Analysis of 43 patients revealed various wrap failure types and contributing factors.
• The structured reporting checklist effectively described wrap integrity and complications.
• The developed format aided in managing complex post-operative cases.

Conclusions:

• Fundoplication wrap failure is a recognized complication of LARS.
• A novel structured CT report with a checklist enhances post-operative evaluation for recurrent symptoms.
• Multislice CT with multiplanar reconstructions is the optimal imaging modality for suspected wrap failures.