Thad Boss

Radiological Findings in Symptomatic Internal Hernias After Laparoscopic Gastric Bypass

BackgroundInternal hernias (IHs) can complicate laparoscopic Roux-en-Y gastric bypass (LRYGB). A number of radiological investigations can be used in the diagnosis. These include plain X-rays, upper gastrointestinal (UGI) series, ultrasound, and computed tomography (CT) scanning. We present radiological findings in our series of 58 symptomatic internal hernias based on our 6-year experience (2000-2006) of 2,572 LRYGB patients.MethodsA retrospective chart review was performed of all patients undergoing LRYGB who developed symptomatic internal hernia requiring operative intervention between January 1, 2000 and September 15, 2006. Types of radiological tests performed and their results were recorded.ResultsFifty-eight symptomatic internal hernias were recorded, of which 56/58 (97%) underwent radiological investigation; 2/58 went directly to surgery. Of the 56 patients who underwent diagnostic imaging, 41 plain abdominal X-rays, 37 CT scans, 26 UGI series, and eight ultrasound scans were performed. Sixty-five percent of UGI series and 92% of CT scans had positive features diagnostic of internal hernia. Performing both CT and UGI series successfully diagnosed IH in 100% of cases. Subgroup analysis did not reveal any association between positive result of imaging test and type of internal hernia.ConclusionCT scanning is the single most effective radiological investigation for diagnosing internal hernias post-LRYGB. In non-diagnostic cases, the addition of an upper GI series increases the diagnostic rate to 100%.

Post-Bariatric Surgery Reconstruction : Patient Myths, Perceptions, Cost, and Attainability Strategies

Background: A discrepancy exists between patient perceptions of post-bariatric surgery reconstruction and cost, value, and ultimate attainability. The authors investigated prospective gastric bypass patients to identify misconceptions and strategies to aid in the attainability of post-bariatric surgery reconstruction. Methods: One hundred seventy-six prospective gastric bypass patients were surveyed for perceptions of plastic surgery, a “club” concept integrating plastic surgical/bariatric teams, and payment strategies. Cost comparisons were set up for comparison with major consumer purchases. Outcome measures were assessed by univariate analyses. Results: One hundred seventy-four patients (139 women and 35 men; mean age, 42.3 years; mean body mass index, 49.3) completed the survey; 65.9 percent expressed an interest in plastic surgery (women were more interested than men) (p < 0.05); 73.1 percent wanted their plastic surgeon affiliated with the bariatric surgeon/team; 47 percent wanted to meet the plastic surgeon before their gastric bypass; and 14.4 percent equated the cost of a total body lift to the cost of a new car versus 31.9 percent for a trip to Disneyworld, 23.8 percent for a television, and 16.3 percent for a radio. Estimated costs for plastic surgery were undervalued by 60 percent. Sixty percent were interested in a club with a monthly fee that would go toward future plastic surgery. Other payment strategies were less popular. None of the independent variables predicted the degree of interest in any particular plan. Conclusions: Future gastric bypass patients, particularly women, are a unique population with common misconceptions regarding post-bariatric surgery reconstruction. Early patient education and financial awareness, in combination with preexisting or newly created bariatric centers, may improve attainability for this population.