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Page 4 of 11 Stier et al. Mini-invasive Surg 2020;4:18 I http://dx.doi.org/10.20517/2574-1225.2019.75

Table 1. Patient data
RYGB SG OAGB/MGB BPD-DS/BPD/SADI-S GB VBG
n 279 (F223/M56) 168 (F142/M26) 78 (F56/M22) 11 (F7/M4) 7 (F7/M0) 15 (F13/M2)
Age (y) 43.88 ± 10.87 45.84 ± 11.11 46.09 ± 9.48 45.86 ± 9.84 46.80 ± 9.26
Height (cm) 166.84 ± 7.93 169.91 ± 10.04 170.14 ± 8.11 166.57 ± 6.65 166.73 ± 9.28
Weight at surgery (kg) 140.88 ± 26.91 159.35 ± 30.58 165.45 ± 29.97 172.00 ± 34.08 152.93 ± 35.78
Weight at examination (kg) 100.03 ± 26.64 120.15 ± 34.26 112.89 ± 34.09 108.91 ± 15.91 126.20 ± 25.42
2
BMI (kg/m ) at surgery 50.68 ± 9.02 55.14 ± 9.12 57.09 ± 8.75 61.61 ± 8.87 54.85 ± 12.16
Excess weight at surgery (kg) 74.0 ± 25.0 89.45 ± 26.53 95.32 ± 26.94 105.43 ± 29.38 86.20 ± 32.52
EWL (%) 57.27 ± 29.28 46.26 ± 26.35 56.12 ± 31.95 55.11 ± 23.89 22.00 ± 45.69
TBWL (kg) 40.92 ± 21.87 39.20 ± 23.44 52.56 ± 33.07 63.09 ± 43.40 26.73 ± 27.12
TBWL (%) 28.75 ± 14.20 24.95 ± 13.70 31.18 ± 17.81 34.11 ± 16.93 15.07 ± 18.69
Time-elapse from surgery to examination (months) 54.28 ± 38.54 27.78 ± 21.71 16.45 ± 15.46 42.14 ± 17.24 173 ± 52.71
RYGB: roux-en-Y gastric bypass; SG: sleeve gastrectomy; BPD: biliopancreatic diversion; GB: gastric banding; VBG: vertical banded
gastrostomy; EWL: excess weight loss; BMI: body mass index; OAGB/MGB: one-anastomosis/mini gastric bypass; Sadi-S: Single
anastmosis duodeno-ileal bypass with sleeve gastrectomy; TBWL: total body weight loss; BPD-DS: biliopancreatic diversion with
duodenal switch

Procedure data
The medium time from primary surgery to introduction was 51.34 ± 46.85 months in the overall cohort (n
= 279). Eleven patients (n = 11) presented with rarer and more dated procedures, including GB and VBG.
In those patients, time between surgery and re-evaluation due to complaints was 173.20 ± 52.71 months.
All those bariatric procedures other than RYGB or SG were combined and added to this third subgroup,
including GB, VBG (together n = 15), BPD (n = 7) and OAGB/MGB (n = 11) procedures (total n = 33).
Analysing the other two main subgroups - RYGB and SG - demonstrated a highly significant difference in
the time between surgery and reported complaints. Time span to the actual reported emergency-evaluation
was 54.3 ± 38.6 months after a RYGB and 27.8 ± 21.7 months after SG (P = 0.0001).

Complaints - weight regain
The vast majority of patients reported non-specific worsening abdominal pain, which was the most
common indication for examination. However, a closer exploration often revealed the most feared patient
concern, which is weight regain (49.82%; 139/276) regardless of the severity of the existing complaints. This
additionally affected 61 patients after SG (78.20% 61/78) and 65 patients after RYGB (38.7%; 65/168). The
medium gastric volume of the 3D volumetry was 174.41 ± 59.36 mL in SG and 47.91 ± 20.86 mL in RYGB.
The Pearson’s chi-square value was calculated for all SG volumes and the contemporarily related EWL. A
bilateral signification of 0.005, (P < 0.01) as inverse relation was found between volume and EWL with a
confidence level of 99%.

GERD and hiatal hernia
GERD was another frequently reported symptom, which affected predominantly patients with SG (39/78;
50%), VBG, GB and BPD (in total, 52/279; 18.63%). After sleeve gastrectomy, 3D-CT revealed in 47.29%
(35/74) a hiatal hernia, whereas, following RYGB, hiatal hernias were detected only in 16.07% (27/168). It is
noteworthy that there was no significant difference in the detection rate or the longitudinal quantitation of a
hiatal hernia, when the results of endoscopic examination and 3D-CT were compared (2.55 ± 0.82 cm vs. 2.24
± 1.13 cm in RYGB and 3.04 ± 1.23 vs. 2.69 ± 1.59 in SG). However, especially in difficult cases, the detailed
imaged anatomy showed more details, which were easier to reveal, and therefore provided additional and
often therapy-critical information. It directly influenced the objectivity of findings and, thus, the decision-
making security. Due to the additional information resulting from 3D-CT, which revealed a twisting,
relative constriction or a remnant and herniated part of the fundus after SG, 12 of the patients underwent
directly conversion to RYGB without previous conservative therapeutic attempt. The major finding was that
3D-CT had direct impact on the resulting patient treatment in more than 21% of cases, without performing
another UGI, which had already previously been carried out without success in the referring departments.