Evaluating the Impact of Preoperative CT scans in Revisional Bariatric Metabolic Surgery: A Single-Institute Experience.

Hany, Mohamed; Ibrahim, Mohamed; Agayby, Ann; Abouelnasr, Anwar Ashraf; Abdelreheim, Moaz; Torensma, Bart

doi:10.21608/jmalexu.2024.314461.1026

Evaluating the Impact of Preoperative CT scans in Revisional Bariatric Metabolic Surgery: A Single-Institute Experience.

Document Type : Original Article

Authors

¹ Department of Surgery, Medical Research Institute, Alexandria University, Egypt

² St. Mary Hospital, NHS, Isle of wight, United Kingdom

³ Department of Radiology, Al Ahly Hospital, Alexandria, Egypt

⁴ Leiden University Medical Center

10.21608/jmalexu.2024.314461.1026

Abstract

Background Radiology can play an essential role in planning and assessment, with the techniques of virtual gastroscopy (VG) or abdominopelvic computerized tomography (APCT) scans.
Method This retrospective study aimed to determine the outcomes of APCT imaging and VG in revisional surgery that impact the decisions for BMS procedures. Group 1 did not affect the surgical plan, and Group 2 directly impacted it, either postponing, modifying it into concomitant/staged surgery, or changing the BMS procedure.
Results: A total of 277 revisional BMS patients underwent a preoperative APCT scan. The incidence of a finding on the APCT was 24.2%, with a direct impact observed in 25.4%. In group 2, 5.4% of the plans were altered (p=0.001), specifically from one anastomosis gastric bypass (OAGB) to laparoscopic sleeve gastrectomy (LSG) due to suspected Crohn's disease. Additionally, 57.9% of surgeries included concomitant procedures. One hundred sixty patients with larger stomach volumes (634±95.3 ml), 63.6% had hiatal hernias with reflux Los Angeles (LA) class B, prompting shifts to roux-en-y-gastric bypass (RYGB) or OAGB from re-LSG procedures. For patients with previous vertical banded gastroplasty (VBG), 10.0% had their surgery plan changed from RYGB to LSG after detecting disrupted staple lines.
Conclusion This study underscores the vital impact of APCT and VG imaging on refining surgical plans in revisional BMS, revealing their key role in detecting critical conditions that necessitate changes in surgical strategy. It emphasizes the importance of collaborative decision-making between radiologists and surgeons to enhance patient outcomes and safety.

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