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Stier et al . Mini-invasive Surg 2020;4:18 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2019.75

Original Article Open Access

Computed tomography-3D-volumetry: a valuable
adjunctive diagnostic tool after bariatric surgery

Christine Stier , Chetan Parmar , Ann-Cathrin Koschker , Mohammed Bokhari , Raphael Stier , Sonja
4
3
5
1
2
Chiappetta 6
1 Bariatric and Metabolic Surgery, Obesity Centre NRW, Sana Hospitals Germany, Huerth 50354, Germany.
2 Bariatric and Metabolic Surgery, The Whittington Hospital NHS Trust, London N19 5NF, UK.
3 Department of Internal Medicine, Division of Endocrinology, University Hospital, University of Würzburg, Würzburg 97080,
Germany.
4 Department of Radiology, Sana Klinikum Offenbach, Offenbach 63069, Germany.
5 Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne 50937, Germany.
6 Bariatric and Metabolic Surgery, Ospedale Evangelico Betania, Napoli 80147, Italy.
Correspondence to: Dr. Christine Stier, Bariatric and Metabolic Surgery, Obesity Centre NRW, Sana Hospitals Germany,
Huerth 50354, Germany. E-mail: christine.stier@sana.de

How to cite this article: Stier C, Parmar C, Koschker AC, Bokhari M, Stier R, Chiappetta S. Computed tomography-3D-
volumetry: a valuable adjunctive diagnostic tool after bariatric surgery. Mini-invasive Surg 2020;4:18.
http://dx.doi.org/10.20517/2574-1225.2019.75

Received: 31 Dec 2019 First Decision: 17 Feb 2020 Revised: 25 Feb 2020 Accepted: 2 Mar 2020 Published: 11 Mar 2020

Science Editor: Wah Yang Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Aim: After bariatric surgery, a variety of complaints may arise. Identification of the causes of such symptoms is often
challenging due to the postoperatively modified anatomy. While standard examinations with upper endoscopy and upper
gastrointestinal series might miss the three-dimensional anatomic nature of the problem, quantitative three-dimensional
computed tomography volumetry (3D-CT) of the upper gastrointestinal tract offers a novel, adjunctive examination,
revealing the detailed anatomy. The aim of this study was to analyse the clinical value of 3D-CT in post-bariatric patients.

Methods: Prospective data of 279 patients, who underwent 3D-CT due to complications after different bariatric
procedures, were retrospectively analysed. Directly before examination, the surgical-modified stomach was distended
with an effervescent-powder. CT images were 3D-reconstructed and, further, gastric volume was calculated.

Results: In total, 279 patients were examined. Time between surgery and examination was significantly different
between Roux-en-Y gastric bypass (n = 168) (54.3 ± 38.6 months) and sleeve gastrectomy (n = 78) (27.8 ± 21.7 months)
(P = 0.0001). Others, less numerous, but included procedures were one-anastomosis/mini gastric bypass (n = 11) , and
dated procedures, such as the vertical banded gastrostomy. The examination allowed calculation of the gastric volume,
and the 3D-reconstructions depicted accurately the pivotable anatomic details of the modified upper gastrointestinal
tract with 360° view. As a robust result, patients with a higher gastric volume showed more weight regain after sleeve
gastrectomy.
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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