Obesity Surgery

, Volume 28, Issue 4, pp 1063–1069 | Cite as

Comparison of Imaging Modalities for Detecting Complications in Bariatric Surgery

  • Sergio Susmallian
  • Eduard Folb
  • Royi Barnea
  • Asnat Raziel
Original Contributions



The purpose of this study is to evaluate the results of routine fluoroscopic swallowing study (FSS) imaging 24 h after surgery and computed tomography (CT) on demand based on clinical data, in diagnosing complications after bariatric surgery.

Material and Methods

This retrospective study includes 9386 patients that underwent bariatric surgery. A total of 3241 (34.53%) patients underwent FSS imaging following the surgical procedure, and 106 (1.13%) patients underwent CT.


Sleeve gastrectomy was performed in 8093 patients (75.81%), gastric bypass was performed in 1281 patients (12%), duodenal switch or biliopancreatic diversion was performed in 12 patients (0.11%), and gastric banding was performed in 1289 patients (12.07%), which were excluded from the study as no imaging modality was used in any of these patients. The sensitivity for FSS was 71.43% and the specificity was 99.85%. An analysis of disease prevalence revealed a value of 0.43% with a positive predictive value of 66.67%. The sensitivity for CT was 71.42% and the specificity was 98%. A disease prevalence analysis revealed a value of 6.60% with a positive predictive value of 83.33%. A comparison of the two modalities showed that FSS has higher specificity values (p < 0.02) and a higher accuracy (p < 0.0001) than CT.


CT and FSS have a similar sensitivity for diagnosing complications after bariatric surgery. However, the specificity and accuracy of FSS are superior to that of CT. This study was approved by the instructional ethics committee (Helsinki board) and was registered on the National Institutes of Health ( web site with identifier NCT02813122.


Bariatric surgery Fluoroscopic swallowing study (FSS) Computed tomography (CT) Postoperative complications 


Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent statement does not apply.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Barbany M, Foz M. Obesity: concept, classification and diagnosis. An Sist Sanit Navar. 2002;25(Suppl 1):7–16.PubMedGoogle Scholar
  2. 2.
    Apovian CM. Obesity: definition, comorbidities, causes, and burden. Am J Manag Care. 2016;22:s176–85.PubMedGoogle Scholar
  3. 3.
    Flegal K, Kit B, Orpana H, et al. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309:71–82.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Follow-up to the political declaration of the high-level meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases, 2013. Geneva: World Health Assembly. Accessed 26 Jan 2014.
  5. 5.
    Li Z, Maglione M, Tu W, et al. Meta-analysis: pharmacologic treatment of obesity. Ann Intern Med. 2005;142(7):532–46.CrossRefPubMedGoogle Scholar
  6. 6.
    Foster GD, Wyatt HR, Hill JO, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003;348:2082–90.CrossRefPubMedGoogle Scholar
  7. 7.
    Wing RR. Physical activity in the treatment of the adulthood overweight and obesity: current evidence and research issues. Med Sci Sports Exerc. 1999;31:S547–52.CrossRefPubMedGoogle Scholar
  8. 8.
    Penick S, Filion R, Fox S, et al. Behavior modification in the treatment of obesity. Psychosom Med. 1971;33(1):49–55.CrossRefPubMedGoogle Scholar
  9. 9.
    Ryan DH, Johnson WD, Myers VH, et al. Nonsurgical weight loss for extreme obesity in primary care settings: results of the Louisiana Obese Subjects Study. Arch Intern Med. 2010;170:146–54.CrossRefPubMedGoogle Scholar
  10. 10.
    Chang SH, Pollack LM, Colditz GA. Obesity, mortality, and life years lost associated with breast cancer in nonsmoking US women, National Health Interview Survey, 1997–2000. Prev Chronic Dis. 2013;10:E186.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Nguyen N, Varela E. Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol. 2016;
  12. 12.
    Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery—an updated systematic review and meta-analysis, 2003–2012. JAMA Surg. 2014;149(3):275–87.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Patel S, Szomstein S, Rosenthal RJ. Reasons and outcomes of reoperative bariatric surgery for failed and complicated procedures (excluding adjustable gastric banding). Obes Surg. 2011;21:1209–19.CrossRefPubMedGoogle Scholar
  14. 14.
    Comeau E, Gagner M, Inabnet WB, et al. Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc. 2005;19:34–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Xu T, Rosculet N, Steele K, et al. Comparison of upper gastrointestinal fluoroscopy versus computed tomography for evaluation of post-operative leak in a bariatric surgery patient. BJR Case Rep. 2016;2:20160076.Google Scholar
  16. 16.
    Shah S, Shah V, Ahmed AR, et al. Imaging in bariatric surgery: service set-up, post-operative anatomy and complications. Br J Radiol. 2014;84(998):101–11.CrossRefGoogle Scholar
  17. 17.
    Kim TH, Kim JH, Shin CI, et al. CT findings suggesting anastomotic leak and predicting the recovery period following gastric surgery. Eur Radiol. 2015;25(7):1958–66.CrossRefPubMedGoogle Scholar
  18. 18.
    Triantafyllidis G, Lazoura O, Sioka E, et al. Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2011;21(4):473–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Bertelson NL, Myers JA. Routine postoperative upper gastrointestinal fluoroscopy is unnecessary after laparoscopic adjustable gastric band placement. Surg Endosc. 2010;24(9):2188–91.CrossRefPubMedGoogle Scholar
  20. 20.
    Upponi S, Ganeshan A, D'Costa H, et al. Radiological detection of post-oesophagectomy anastomotic leak—a comparison between multidetector CT and fluoroscopy. Br J Radiol. 2008;81:545–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Hamilton EC, Sims TL, Hamilton TT, et al. Clinical predictors of leak after laparoscopic Roux-en-Y gastric- bypass for morbid obesity. Surg Endosc. 2003;17:679–84.CrossRefPubMedGoogle Scholar
  22. 22.
    Swanson JO, Levine MS, Redfern RO, et al. Usefulness of high-density barium for detection of leaks after esophagogastrectomy, total gastrectomy, and total laryngectomy. Am J Roentgenol. 2003;181(2):415–20.CrossRefGoogle Scholar
  23. 23.
    Leopold GR, Asher M. Deleterious effects of gastrointestinal contrast material on abdominal echography 1. Radiology. 1971;98(3):637–40.CrossRefPubMedGoogle Scholar
  24. 24.
    Vessal K, Montali RJ, Larson SM, et al. Evaluation of barium and gastrografin as contrast media for the diagnosis of esophageal ruptures or perforations. AJR Am J Roentgenol. 1975;123(2):307–19.CrossRefGoogle Scholar
  25. 25.
    Zheutlin N, Lasser EC, Rigler LG. Clinical studies on effect of barium in the peritoneal cavity following rupture of the colon. Surgery. 1952;32:967–79.PubMedGoogle Scholar
  26. 26.
    Lainas P, Tranchart H, Gaillard, et al. Prospective evaluation of routine early computed tomography scanner in laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(8):1483–90.CrossRefPubMedGoogle Scholar
  27. 27.
    Mizrahi I, Tabak A, Grinbaum R, et al. The utility of routine postoperative upper gastrointestinal swallow studies following laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(9):1415–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Bingham J, Shawhan R, Parker R, et al. Computed tomography scan versus upper gastrointestinal fluoroscopy for diagnosis of staple line leak following bariatric surgery. Am J Surg. 2015;209(5):810–4.CrossRefPubMedGoogle Scholar
  29. 29.
    Rawlins L, Penn R, Schirmer B, et al. Accuracy of routine postoperative swallow study in predicting leak or obstruction after gastric bypass. Surg Obes Relat Dis. 2015;11(1):1–4.CrossRefPubMedGoogle Scholar
  30. 30.
    Lottrup C, Gregersen H, Liao D, et al. Functional lumen imaging of the gastrointestinal tract. J Gastroenterol. 2015;50(10):1005–16.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Sergio Susmallian
    • 1
  • Eduard Folb
    • 2
  • Royi Barnea
    • 3
  • Asnat Raziel
    • 4
  1. 1.Department of SurgeryAssuta Medical CenterTel AvivIsrael
  2. 2.Department of RadiologyAssuta Medical CenterTel-AvivIsrael
  3. 3.Assuta Health Services Research InstituteAssuta Medical CenterTel-AvivIsrael
  4. 4.Assia Medical GroupAssuta Medical CenterTel-AvivIsrael

Personalised recommendations