Bariatric/Metabolic surgery for the radiologist: Clinical insight, normal post-operative imaging and imaging of complications

APPLIED RADIOLOGY © n 7 December 2016 The current obesity epidemic in the U.S. is associated with major medical and social problems accompanied by increased morbidity and mortality, which is proportional to the degree of excess weight.1 In “Bariatric/ Metabolic Surgery for the Radiologist: Clinical Insight, Normal Post-Operative Imaging and Imaging of Complications. Part 1 Gastric Restrictive Surgery,” the body mass index (BMI), the BMI obesity scale, and the indications for bariatric procedures were reviewed. Bariatric procedures are classified as restrictive, malabsorptive or a combination of both. Laparoscopic adjustable gastric banding and laparoscopic sleeve gastrectomy are purely restrictive procedures, which rely on decreased food intake and dietary modification for weight loss. Laparoscopic Roux-en-Y gastric bypass (LRYGB), presently the most commonly performed bariatric operation in the U.S., combines gastric restriction and malabsorption to achieve weight loss, by creating a small gastric pouch and a jejuno-jenunal bypass. Bilio-pancreatic diversion with duodenal switch, another type of bypass, is technically more challenging and commonly reserved for the super obese patient with BMI > 55 or for revision of failed bariatric procedures. LRYGB can result in control of diabetes and hypertension within weeks of surgery. This article highlights and reviews the clinical and radiological features of normal LRYGB; in addition, it reviews the radiologic appearances of complications, which are summarized in Table 1.