Laparoscopic Adjustable Gastric Banding Surgery for Morbid Obesity: Imaging of Normal Anatomic Features and Postoperative Gastrointestinal Complications
Arye Blachar1,2,3,
Annat Blank1,2,
Nancy Gavert2,4,
Ur Metzer1,2,
Gideon Fluser1,2 and
Subhi Abu-Abeid2,4
1 Department of Radiology, Tel Aviv Sourasky Medical Center, 6 Weizman St., Tel
Aviv 64239, Israel.
2 The Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239,
Israel.
3 University of Pittsburgh Medical Center, Pittsburgh, PA 15213.
4 Department of Surgery B, Bariatric Surgery Service, Tel Aviv Soursaky Medical
Center, Tel Aviv 64239, Israel.
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Fig. 2A —56-year-old woman with normal anatomic findings after laparoscopic
adjustable gastric banding. Esophagogram shows contrast material passing
through esophagus (E) and stoma into stomach (S). Band (arrow) is
properly located.
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Fig. 2B —56-year-old woman with normal anatomic findings after laparoscopic
adjustable gastric banding. Axial CT section at level of band (arrow)
shows small gastric pouch (GP) and contrast material in stomach.
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Fig. 3A —26-year-old woman with acute stomal stenosis 7 months after
laparoscopic adjustable gastric banding surgery. Symptom was recurrent
vomiting that increased in severity. Esophagogram shows dilated upper pouch
(P) and minute passage of contrast material through narrow stoma
(arrow).
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Fig. 3B —26-year-old woman with acute stomal stenosis 7 months after
laparoscopic adjustable gastric banding surgery. Symptom was recurrent
vomiting that increased in severity. Esophagogram after band deflation shows
normal passage of contrast material (arrow) from esophagus (E) to
stomach (S).
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Fig. 4 —32-year-old woman with chronic stomal stenosis with concentric
dilatation 1 year after surgery. Symptoms were intermittent vomiting and
weight gain. Esophagogram shows markedly dilated pouch (black arrows)
containing food debris. Band (white arrow) has migrated inferiorly
and is located just below diaphragm.
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Fig. 5 —57-year-old woman with severe chronic stomal stenosis necessitating
band removal, after which symptoms eventually resolved. Esophagogram shows
markedly dilated and tortuous sigmoid esophagus (E) with no passage of
contrast material through slightly malpositioned band (arrow).
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Fig. 6 —50-year-old woman with heartburn and difficulty swallowing.
Gastroscopy revealed presence of meat and dried fruit residue. Esophagogram
shows constant filling defect (black arrow) in distal esophagus (E)
just above band with normal passage of contrast material (white
arrow) to stomach (S).
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Fig. 7 —65-year-old man with filling defect due to tumor. Symptom was weight
gain; no obstructive symptoms occurred. Biopsy at gastroscopy showed
metastasis of malignant melanoma. Esophagogram shows large filling defect
(thin white arrow) in distal esophagus (E). Irregularity of
esophageal wall (thick arrow) and normal passage of contrast material
through band (black arrow) into stomach (S) are evident.
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Fig. 8A —42-year-old woman with posterior band slippage 8 months after
surgery. Symptoms were recurrent vomiting, abdominal pain, regurgitation, and
chronic cough due to recurrent aspiration. Esophagogram shows posterior
slippage of proximal pouch (P) inferior in relation to vertically
malpositioned band (arrow). E = esophagus.
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Fig. 8B —42-year-old woman with posterior band slippage 8 months after
surgery. Symptoms were recurrent vomiting, abdominal pain, regurgitation, and
chronic cough due to recurrent aspiration. Coronal multiplanar CT
reconstruction shows band (arrow) has slipped from its normal
position immediately below gastroesophageal junction. Gastric pouch (GP) is
larger than expected. S = stomach.
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Fig. 9 —50-year-old woman with anterior band slippage with recurrent
vomiting and upper abdominal discomfort. Esophagogram shows proximal pouch (P)
is superior in relation to inferiorly positioned band (arrow). E =
esophagus.
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Fig. 10 —40-year-old woman with band slippage, persistent vomiting due to
posterior band slippage, and surgically proven gastric volvulus. Barium
esophagogram shows lateral position of band (thick arrow) with
inferior dilated pouch (P) consistent with posterior slippage. Distal part of
stomach (S) is above band, and because of gastric volvulus, greater curvature
(thin arrow) is superior in relation to lesser curvature.
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Fig. 11A —51-year-old man with band perforation and peritonitis 2 weeks after
surgery. Symptoms were fever and abdominal pain. Axial CT scan shows
extraluminal air (thin arrow) adjacent to band (white thick
arrow) and proximal stomach. Free perisplenic air and fluid (black
thick arrow) are evident.
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Fig. 11B —51-year-old man with band perforation and peritonitis 2 weeks after
surgery. Symptoms were fever and abdominal pain. Esophagogram shows free air
(thin arrows) surrounding band and catheter. Extraluminal contrast
material (thick arrow) around band and passage of contrast medium
through band from esophagus (E) into stomach (S) are evident.
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Fig. 12A —46-year-old man with large left subphrenic abscess managed with
CT-guided abdominal abscess drainage. Axial CT scan at level of gastric band
(arrow) shows large perisplenic fluid collection (C). S = stomach, SP
= spleen.
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Fig. 12B —46-year-old man with large left subphrenic abscess managed with
CT-guided abdominal abscess drainage. Axial CT scan at same level as A
after successful drainage of abscess. Pigtail catheter (thin arrow)
in remaining fluid collection and intraperitoneal portion of catheter
(thick arrow) are evident. S = stomach, SP = spleen.
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Fig. 13 —47-year-old woman with band erosion and sustained weight gain 2
years after surgery. Esophagogram shows contrast material (arrow)
passing around band instead of through it, suggesting intragastric band
location. E = esophagus.
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Fig. 14 —21-year-old man with port disconnection. Symptom was recent weight
gain after maintenance of 30-kg weight loss since surgery. Radiograph of
abdomen shows port end of catheter (thin arrow) disconnected from
catheter (thick arrow).
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Fig. 15 —27-year-old woman with catheter leakage 5 weeks after surgery.
Radiograph obtained after injection of contrast material through port
(thick arrow) shows leakage of contrast material from catheter into
peritoneal cavity (thin arrows).
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Fig. 16 —40-year-old man with band leakage 6 months after surgery. Symptom
was weight gain despite previous inflation of cuff. Fluoroscopic image with
contrast material injected through port shows extravasation of contrast
material from band (thick arrow). Contrast material (thin
arrows) is evident in peritoneal cavity.
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Fig. 17 —38-year-old woman with "aneurysm" of band 1 year after
surgery. Symptom was nonspecific upper abdominal discomfort developing over
previous 3 months and more apparent after eating. Radiograph obtained after
injection of contrast material through port (black thick arrow) shows
uneven inflation of sleeve inside band (white thick arrow) resembling
aneurysmal dilatation due to technical failure. Clips (thin arrow)
from cholecystectomy are evident.
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Fig. 18 —45-year-old woman with port infection. Symptom was pain in port
area. Port puncture yielded turbid fluid drawn from port-catheter system.
Axial CT scan shows fluid and infiltration of subcutaneous fat surrounding
port (thin arrows) and catheter (thick arrow).
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