Purpose: The aim of the study was to evaluate the role of radiological upper gastroenteric studies to detect early and postoperative complications after gastric restrictive surgery for obesity.
Materials and methods: From October 1992 to October 2002, 650 patients submitted to vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGBP) underwent radiological follow-up to assess the presence of both early and late postoperative complications. The patients were 546 (84%) women and 104 (16%) men whose average weight was 125 kg (range: 78 to 218 kg). The average female age was 37 years (range: 17 to 69 years) and the average male age 36 (range: 19 to 64 years). Preoperative mean body mass index was 46 kg/m2 (range 31-78 kg/m2). The patients underwent radiological upper gastroenteric investigation employing water soluble contrast material between the 4th and 7th postoperative day. All patients underwent another late examination every year after surgery.
Results: At 10 years follow-up in 620 patients submitted to modified Mason VBG we observed the following early postoperative complications: 16 cases (2.6%) of oedema of the stoma, six cases (0.9%) of gastro-oesophageal reflux, one case (0.2%) of staple-line disruption, and one case (0.2%) of intragastric haemorrhage. Late complications in VBG included 26 cases (4.2%) of staple-line disruption, four cases (0.6%) of kinked stomas, six cases (0.9%) of pouch dilatations, two cases (0.4%) of stomal stenosis and one case (0.2%) of gastro-oesophageal reflux. In 30 RYGBP patients we observed the following early postoperative complications: one case (0.8%) of dilated pouch, one case (0.8%) of oedema of the anastomosis and one case (0.8%) of anastomotic leak. Late postoperative complications in the 30 RYGBP patients included three cases (2.5%) of stomal ulcers and one case (0.8%) of gastro-oesophageal reflux. We also examined the annual incidence of complications in late follow-up.
Discussion and conclusions: Both early and late radiological studies after gastric bariatric surgery enable the detection of postoperative complications and provided morphological and volumetric data after VBG and RYGBP. Post-operative complications (gastric perforation, stomal stenosis, etc.) need to be emphasised and the clinical approach modified to enable suitable weight loss.