Complications of sleeve gastrectomy are often evaluated by imaging. For details about the surgical procedure, please see the parental article on sleeve gastrectomy.
Complications
Postoperative complications can be classified by etiology or temporality.
Early complications
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staple line leakage
clinical presentation: epigastric pain, fever, leukocytosis, +/- referred left shoulder pain due to phrenic nerve irritation
usually occurs within the first week postoperatively due to dehiscence of the staples, near the gastro-esophageal junction
CT findings include extravasation of orally administrated contrast media, extraluminal air foci and perigastric collection or abscess formation
fluoroscopy is the modality of choice for diagnosis of post sleeve leakage
hemorrhage/hematoma: high-density perigastric collection, if it is large it can be drained under image guidance
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splenic injury
splenic infarction (most common)
laceration and subcapsular hematoma (less common)
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occurs due to dehydration
can affect portal vein or one of its branches, splenic, or superior mesenteric vein
Late complications
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gastric dilatation
patient regain weight with dilatation of the sleeved stomach
fluoroscopy and CT with oral contrast may show increased dilatation of the stomach, greater than expected post-operatively
gallstones: rapid loss of weight results in gallstone formation (usually multiple and small)
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due to interruption of the normal fixation mechanism of the stomach
usually presents with symptoms of gastro-esophageal reflux disease (GERD)
easily diagnosed on fluoroscopy and CT
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can occur early (secondary to edema or ischemia) or late (secondary to fibrosis)
usually affecting the distal gastric pouch
gastro-esophageal reflux disease: can arise de novo or exacerbate existing disease 5
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