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array:23 [ "pii" => "S2173510718300053" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2018.02.005" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1024" "copyright" => "SERAM" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2018;60:143-51" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 2 "PDF" => 2 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0033833817302163" "issn" => "00338338" "doi" => "10.1016/j.rx.2017.12.001" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1024" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2018;60:143-51" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 336 "formatos" => array:2 [ "HTML" => 251 "PDF" => 85 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>" "titulo" => "Estudio de las complicaciones de la cirugía bariátrica por tomografía computarizada multidetector con contraste intravenoso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "143" "paginaFinal" => "151" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Studying the complications of bariatric surgery with intravenous contrast-enhanced multidetector computed tomography" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figura 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1423 "Ancho" => 1512 "Tamanyo" => 258582 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Hernia interna en un paciente intervenido de BPG. A) Corte axial de TCMDcCIV en el que se observa una dilatación de las asas de intestino delgado localizadas en el cuadrante superior izquierdo (flechas) adyacentes a la anastomosis proximal gastroyeyunal (asterisco). B) Corte coronal de TCMDcCIV en el que se comprueba que las asas intestinales dilatadas están en una posición cefálica con respecto al colon transverso (asterisco). C) Corte axial de TCMDcCIV en el que se aprecia una lateralización hacia el lado derecho de la anastomosis distal yeyunoyeyunal (asterisco). D) Corte sagital de TCMDcCIV en el que se identifica un remolino de los vasos mesentéricos (círculo) acompañado de obstrucción intestinal en otro paciente que presentó hernia interna.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Morandeira, M.V. Bárcena, A. Bilbao, M. Pérez, A.M. Ibáñez, M. Isusi, G. Lecumberri" "autores" => array:7 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Morandeira" ] 1 => array:2 [ "nombre" => "M.V." "apellidos" => "Bárcena" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Bilbao" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Pérez" ] 4 => array:2 [ "nombre" => "A.M." "apellidos" => "Ibáñez" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Isusi" ] 6 => array:2 [ "nombre" => "G." "apellidos" => "Lecumberri" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173510718300053" "doi" => "10.1016/j.rxeng.2018.02.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510718300053?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833817302163?idApp=UINPBA00004N" "url" => "/00338338/0000006000000002/v1_201804040507/S0033833817302163/v1_201804040507/es/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S217351071830003X" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2018.02.003" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1025" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2018;60:136-42" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 2 "PDF" => 2 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Report</span>" "titulo" => "Intraoperative 3<span class="elsevierStyleHsp" style=""></span>tesla magnetic resonance imaging: Our experience in tumors" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "136" "paginaFinal" => "142" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resonancia magnética intraoperatoria de 3 teslas: Nuestra experiencia en patología tumoral" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2007 "Ancho" => 2501 "Tamanyo" => 329758 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Transfer of the patient from the operating room to the intraoperative magnetic resonance imaging room (A and B). Schematic drawing showing the location of the MRI and other rooms (C).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. García-Baizán, A. Tomás-Biosca, P. Bartolomé Leal, P.D. Domínguez, R. García de Eulate Ruiz, S. Tejada, J.L. Zubieta" "autores" => array:7 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "García-Baizán" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Tomás-Biosca" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Bartolomé Leal" ] 3 => array:2 [ "nombre" => "P.D." "apellidos" => "Domínguez" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "García de Eulate Ruiz" ] 5 => array:2 [ "nombre" => "S." "apellidos" => "Tejada" ] 6 => array:2 [ "nombre" => "J.L." "apellidos" => "Zubieta" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833817302175" "doi" => "10.1016/j.rx.2017.12.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833817302175?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217351071830003X?idApp=UINPBA00004N" "url" => "/21735107/0000006000000002/v1_201803220924/S217351071830003X/v1_201803220924/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Report</span>" "titulo" => "Studying the complications of bariatric surgery with intravenous contrast-enhanced multidetector computed tomography" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "143" "paginaFinal" => "151" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C. Morandeira, M.V. Bárcena, A. Bilbao, M. Pérez, A.M. Ibáñez, M. Isusi, G. Lecumberri" "autores" => array:7 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Morandeira" "email" => array:1 [ 0 => "morandeiraclara@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.V." "apellidos" => "Bárcena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Bilbao" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "A.M." "apellidos" => "Ibáñez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Isusi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "G." "apellidos" => "Lecumberri" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de investigación, Hospital Universitario Basurto, Bilbao, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio de las complicaciones de la cirugía bariátrica por tomografía computarizada multidetector con contraste intravenoso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2006 "Ancho" => 969 "Tamanyo" => 188907 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Bowel obstruction 13 days after undergoing one GBP. (A) IVCE-MDCT on the paracoronal plane showing one dilated alimentary limb (arrows) formed by jejunum from the proximal gastrojejunal anastomosis (white asterisk) toward the distal jejunojejunal anastomosis (asterisk) without identification of the underlying cause. (B) IVCE-MDCT on the sagittal plane showing one dilated jejunal alimentary limb in the anterior position (arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Obesity is a chronic condition defined<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> as a body mass index (BMI) over 30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>. It is considered a worldwide epidemic, and in Spain it affects 16.9% of the population over 18.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1–3</span></a> Today, there is an important increase of bariatric surgeries due to the higher incidence rate of this condition, the lack of conservative treatment, and the improved results coming from the surgical procedures,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> that not only achieve weight reductions, but also help maintain these drops, and reduce the associated comorbidity.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4–6</span></a> At our hospital, after positive assessment by the units of endocrinology and psychiatry, the unit of general surgery completes the surgical indication based on the patient's characteristics, such as the BMI, any associated comorbidities, the symptomatic abdominal surgical pathology, and the clinical repercussion on the quality of life of obesity.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although complications due to bariatric surgery are growing thin,<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5,7</span></a> patients need one multidisciplinary approach where radiologists play a fundamental role in the detection of complications, particularly thanks to the increased availability of the intravenous contrast-enhanced multidetector computed tomography (IVCE-MDCT).<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8–11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Our goal is to review the postoperative complications of bariatric surgery and their diagnosis using the IVCE-MDCT.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">One retrospective study of all the patients operated of bariatric surgery was conducted at our center. This review was approved by our hospital clinical research ethics committee. All patients operated through gastric bypass procedure (GBP), or sleeve gastrectomy (SG) procedure for the management of their morbid obesity from January 2013 through December 2014 were included in the study. Both the clinical histories (sociodemographic variables, and clinical evolution), and the radiologic imaging modalities conducted in these patients until December 2015 were reviewed, being the major abdominal complications derived from the radiologic diagnosis assessed and categorized into early (within the first month after the intervention), and late complications (within the second month after the intervention).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Both the IVCE-MDCT and the barium swallow study (BS) were considered diagnostic methods. Whenever the complication was acute, or the patient was hemodynamically unstable, the IVCE-MDCT was conducted. The BSs were reserved for chronic complications and cases with non-diagnostic IVCE-MDCT. Also, through the first half of the year 2013, scheduled BSs were conducted in all patients within the first 48<span class="elsevierStyleHsp" style=""></span>h after the surgical procedure, in order to rule out dehiscence of sutures, and confirm correct bowel transits. The IVCE-MDCTs were conducted using one Siemens Somaton Emotion machine, and the images were reconstructed with 2.5<span class="elsevierStyleHsp" style=""></span>mm slices. Eighty ml of intravenous contrast (IVC) were administered <span class="elsevierStyleItalic">Iomeron 300</span> (lomeprol 1<span class="elsevierStyleHsp" style=""></span>g/100<span class="elsevierStyleHsp" style=""></span>ml) at a flow rate of 2<span class="elsevierStyleHsp" style=""></span>ml/s, and a 60 second-delay. On suspicion of bleeding, triphasic studies were indicated, conducting one arterial phase with 120<span class="elsevierStyleHsp" style=""></span>ml of IVC at a flow rate of 4<span class="elsevierStyleHsp" style=""></span>ml/s. On suspicion of dehiscence of sutures or perforation, a series with oral contrast of Gastrolux was added (meglumine amidotrizoate, and sodium amidotrizoate 3.7<span class="elsevierStyleHsp" style=""></span>g/100<span class="elsevierStyleHsp" style=""></span>ml) at a 5/100 dilution. All studies were reviewed by four (4) expert radiologists included in the authorship of the paper, three of them with over 20 years of experience in abdominal radiology.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">One hundred and fifty-five (155) cases were reviewed. The sociodemographic variables are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. There were 24 complications in 22 patients. The complications and their radiologic findings are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. On the one hand, sixteen (16) complications occurred within the first month after the procedure. Seven (7) intraperitoneal hemorrhages (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), two (2) dehiscences of sutures (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), two (2) bowel obstructions (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), and two (2) hernias of the abdominal wall (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) were diagnosed. On the other hand, there were eight (8) complications within the second month after the surgical procedure: three (3) internal hernias (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>), three (3) bowel perforations, and two (2) ulcers of the gastric mucosa adjacent to the surgical sutures (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>). The complications were managed through surgical procedures in 15 patients, and conservative treatment in 9 patients. Yet despite of all this, 2 patients (1.3%) died during the postoperative period. The first patient underwent one SG procedure since the BMI was 78.3<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>. The patient had low blood pressure levels three (3) days after the surgical procedure, and the IVCE-MDCT confirmed presence of a large-volume hemoperitoneum. The patient was surgically operated but died during the postoperative period due to multiple organ failure. The second patient underwent one SG procedure since the BMI was 71.55<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, and six (6) days after the surgical procedure, presented with abdominal pain, and purulent fluid effusion from the abdominal drainage. The IVCE-MDCT diagnosed dehiscence of sutures, but the patient died due to septic shock, yet despite the surgical procedure.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Among all the patients with complications, 21 (95.5%) were diagnosed using the IVCE-MDCT, and one (4.5%) needed a BS to achieve diagnosis. It was one patient who, one year after being operated through one GBP for having a BMI of 40.7<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, started having problems of dysphagia. The IVCE-MDCT conducted turned out normal, and the BS confirmed the presence of stenosis of the gastroduodenal anastomosis with one perianastomotic ulceration. Also, in the group of uncomplicated patients, IVCE-MDCTs were conducted on 23 patients (52.27% of all the IVCE-MDCTs conducted) on suspicion of complications.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Three (3) surgical procedures were identified. In the first place, 66% of the patients underwent one GBP, which is the technique of choice and consists of dividing the stomach using staples into one 15–35<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>-fundic pouch and one excluded stomach. After this, one jejunal loop is cut off at 25–50<span class="elsevierStyleHsp" style=""></span>cm from the ligament of Treitz, and its distal edge is anastomosed with the gastric remnant, forming the alimentary limb in antecolic or retrocolic location with respect to the transverse colon. Finally, the proximal edge of the cut off jejunal loop is anastomosed with one small bowel loop at 75–150<span class="elsevierStyleHsp" style=""></span>cm from the gastrojejunostomy procedure. This is the way to one combined technique both restrictive and malabsorptive<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,2,5,8–12</span></a> with good results in weight reduction and improved associated comorbidity.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,11–14</span></a> Secondly, almost 31% of the patients underwent one SG procedure indicated both in superobese (BMI<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>55<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>) and patients at high surgical risk, or pathology requiring endoscopic controls.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,5</span></a> This procedure consists of dividing the stomach by performing the resection of one part of the gastric cavity along the greater curvature. This is one restrictive technique only,<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,5,9–11</span></a> with worse clinical outcomes because there are more chances of weight gain due to the progressive dilatation of the stomach.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> Thirdly, five (5) patients underwent one surgical reconversion, that is, first the SG procedure was conducted, and after achieving an adequate reduction of the BMI and the associated comorbidity, the treatment was completed conducting one GBP.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Most were early complications. The intraperitoneal bleeding was the most common of all and the one that killed the patient. Other studies show a similar incidence rate, between 0.6 and 4%. These patients require surgical management when they are hemodynamic unstable, being the gastrojejunostomy procedure the most common bleeding site during the GBP.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,2,6</span></a> The second early most common complication was the dehiscence of sutures that also led to the patient's death. Other series show incidence rates of complications around 6% during the GBP–slightly higher in the SG procedure.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> In these cases, the clinical manifestations may be unspecific and progress rapidly to sepsis, requiring the unstable patients surgical reintervention.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,6,15</span></a> In the GBP, the most common location is the gastrojejunal anastomosis.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,5,7</span></a> Only two (2) early obstructions were diagnosed, yet it is the most common complication in other series published. The main cause is the presence of edema, or hematoma in the anastomosis. During the GBP, the obstruction site is usually found in the gastrojejunostomy procedure, particularly in patients with antecolic reconstruction of the alimentary limb.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,5,7,11</span></a> Finally, there were two (2) external hernias. The incidence rate was low due to a greater tendency to perform laparoscopic approaches.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">At the beginning of the second month, eight (8) complications occurred. Three (3) internal hernias occurred in patients operated through GBP, defined as the herniation of bowel loops through a solution of internal continuity that, in these patients, is secondary to surgical procedures, showing laxity due to rapid weight loss. The incidence rate of our series is lower than that of other studies published so far, even though the risk is higher as the number of laparoscopic procedures increases, since there are fewer adhesions,<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,2,4,6,8,11,12,15–20</span></a> and they are more common in the GBP with retrocolic reconstruction because of the need to make one orifice caudal to the transverse colon.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> Complications can be transmesocolic (when the loops become herniated through a defect in the transverse mesocolon); transmesenteric (when the solution of continuity is in the small bowel mesentery through jejunojejunostomy procedure), or Petersen hernias (the herniated loops occupy the Petersen's space created between the jejunal mesentery of the alimentary limb and the transverse mesocolon).<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15–19</span></a> The clinical manifestations are chronic and sporadic, although they can cause acute complications, such as obstructions, or bowel ischemia, and require surgical treatment.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4,11–13,16–20</span></a> Also, there are other causes of late obstructions such as postoperative flanges, invaginations, or bezoars, that our patients did not show.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,10</span></a> Other late complications were bowel perforations, and ulcers in the surgical scar, they were due to poor dietetic control, and had a similar incidence rate to that reported by other studies.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In our series we did not take into account minor complications such as cholelithiasis, or gastroesophageal reflux; complications from non-radiologic diagnoses (dumping syndrome, or gastritis); or non-abdominal complications.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> We did not objectivize either certain major abdominal complications from radiologic diagnoses described in other series, such as splenic and hepatic infarctions<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a>; or bowel ischemias.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The complications are non-specific of the surgical procedure.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> However, some studies say that these complications are more common in patients operated through GBP, although no differences in the life-threatening risks have ever been reported.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,5,14</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The IVCE-MDCT is the first imaging modality of choice in the diagnosis of major complications due to bariatric surgery.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,12,20</span></a> When hemorrhages are suspected, it allows us to diagnose and locate them, and assess whether or not there is active bleeding. In the presence of dehiscence of sutures, or perforation, the presence of pneumoperitoneum and free fluid is characteristic. Also, the administration of oral contrast in these patients is recommended in order to identify the site of the leakage. In patients operated through GBP, the presence of oral contrast in the excluded stomach is usually secondary to reflux, and should not be mixed up with collections.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,8,11,20</span></a> When an obstruction is suspected, the IVCE-MDCT shows the bowel loops damaged, rules out any associated complications, and identifies the obstruction site. When it comes to hernias, the IVCE-MDCT also allows us to exclude the presence of any additional complications. In the diagnosis of internal hernias, although the IVCE-MDCT is the preferred imaging modality, the radiologic findings are not sensitive nor specific, so when suspicion is high, these hernias should be managed surgically even if the IVCE-MDCT looks normal.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,6,11,16,18–20</span></a> The most specific finding in these patients is the twisted mesenteric vessels associated to bowel obstructions.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4,18</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In the study there is a significant amount of radiologic imaging modalities conducted in uncomplicated patients. Most were BS procedures scheduled during the first surgical procedures in order to confirm the presence of a correct transit.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15,20</span></a> Afterwards, the guidelines rejected the indication of this imaging modality and postoperative IVCE-MDCTs in asymptomatic patients due to their scarce sensitivity rate.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> This is why radiologic imaging modalities should only be conducted when on suspicion of complications.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The limitations of this study are its retrospective nature, and the fact that it was limited to one single hospital only.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In sum, bariatric surgery is an increasingly popular surgical procedure, yet despite the fact that the rate of complications is high, and the rate of mortality is not negligible. It is essential to know what these patients’ normal findings look like to be able to identify any possible complications, most of them diagnosed using the IVCE-MDCT.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Authors</span><p id="par0085" class="elsevierStylePara elsevierViewall">Manager of the integrity of the study: CM and MB.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Study Idea: CM and MB.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Study Design: MB, MP and AI.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Data Mining: CM and MB.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Data Analysis and Interpretation: CM and AB.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Statistical Analysis: AB.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Reference: CM, MB, GL and MI.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Writing: CM and MB.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant remarks: CM, MB, AB, MP, AI, MI and GL.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Approval of final version: CM, MB, AB, AI, MP, MI and GL.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests associated with this article whatsoever.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1006463" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec966175" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1006462" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec966174" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:2 [ "identificador" => "xack339434" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-02-21" "fechaAceptado" => "2017-12-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec966175" "palabras" => array:4 [ 0 => "Bariatric surgery" 1 => "Postoperative complications" 2 => "Multidetector computed tomography" 3 => "Contrast agent" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec966174" "palabras" => array:4 [ 0 => "Cirugía bariátrica" 1 => "Complicaciones posoperatorias" 2 => "Tomografía computarizada multidetector" 3 => "Contraste" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To review the complications of bariatric surgery and their diagnosis with intravenous contrast-enhanced multidetector computed tomography (MDCT).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We retrospectively studied all patients who underwent gastric bypass or sleeve gastrectomy at our center during 2013 or 2014. We classified complications into early complications (appearing within 30 days of the intervention) and late complications.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We reviewed 155 cases and found 24 complications in 22 patients: 16 early complications (7 intraperitoneal hematomas, 5 anastomotic dehiscences, 2 intestinal obstructions, and 2 external hernias) and 8 late complications (3 internal hernias, 3 intestinal perforations, and 2 marginal ulcers). Two patients died. All of these complications were diagnosed with intravenous contrast-enhanced MDCT, except one, which required a barium transit study.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The rate of complications in bariatric surgery is high and the associated mortality is not negligible. Radiologists need to know the normal findings in these patients so they can quickly identify possible complications, most of which can be diagnosed with intravenous contrast-enhanced MDCT.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Revisar las complicaciones de la cirugía bariátrica y su diagnóstico mediante tomografía computarizada multidetector con contraste intravenoso (TCMDcCIV).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de los pacientes intervenidos mediante <span class="elsevierStyleItalic">by-pass</span> gástrico o gastrectomía tubular en nuestro centro durante 2013 y 2014. Las complicaciones se dividieron en precoces (durante el primer mes) y tardías.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se revisaron 155 casos y se diagnosticaron 24 complicaciones en 22 pacientes: 16 precoces (7 hematomas intraperitoneales, 5 dehiscencias anastomóticas, 2 obstrucciones intestinales y 2 hernias externas) y 8 tardías (3 hernias internas, 3 perforaciones intestinales y 2 úlceras en boca anastomótica). Dos pacientes fallecieron. Todas las complicaciones se diagnosticaron mediante TCMDcCIV, excepto una que requirió un tránsito baritado.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La tasa de complicaciones en la cirugía bariátrica es elevada y su mortalidad no es despreciable. Deben reconocerse los hallazgos normales en estos pacientes para identificar rápidamente las posibles complicaciones, diagnosticadas en su mayoría mediante TCMDcCIV.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Morandeira C, Bárcena MV, Bilbao A, Pérez M, Ibáñez AM, Isusi M, et al. Estudio de las complicaciones de la cirugía bariátrica por tomografía computarizada multidetector con contraste intravenoso. Radiología. 2018;60:143–151.</p>" ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3205 "Ancho" => 1662 "Tamanyo" => 338129 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Hematoma at the foot of the loop in a patient operated through GBP. (A) MDCT on the axial plane without IVC showing one hyperdense collection (47<span class="elsevierStyleHsp" style=""></span>HU) adjacent to the gastrojejunostomy procedure (asterisk). (B) IVCE-MDCT on the axial plane in the venous phase not showing contrast extravasation (48<span class="elsevierStyleHsp" style=""></span>HU).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1830 "Ancho" => 966 "Tamanyo" => 205421 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Dehiscence of sutures in a patient operated through SG procedure. (A) IVCE-MDCT on the axial plane showing perisplenic free fluid (black asterisk), and one perihepatic collection (white asterisk). (B) IVCE-MDCT on the coronal plane after the administration of oral contrast showing the leakage of contrast medium through the gastrectomy line toward the left subphrenic space (arrow).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2006 "Ancho" => 969 "Tamanyo" => 188907 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Bowel obstruction 13 days after undergoing one GBP. (A) IVCE-MDCT on the paracoronal plane showing one dilated alimentary limb (arrows) formed by jejunum from the proximal gastrojejunal anastomosis (white asterisk) toward the distal jejunojejunal anastomosis (asterisk) without identification of the underlying cause. (B) IVCE-MDCT on the sagittal plane showing one dilated jejunal alimentary limb in the anterior position (arrows).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1865 "Ancho" => 962 "Tamanyo" => 172507 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Eventration of bowel through the trocar orifice in a patient operated through GBP. (A) MDCT on the sagittal plane with IVC showing the herniation of one small bowel loop running through the abdominal wall and following the trajectory of the surgical trocar (arrow). (B) MDCT on the axial plane with IVC showing the anterograde bowel obstruction determined by it (white asterisk).</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1423 "Ancho" => 1512 "Tamanyo" => 256646 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Internal hernia in a patient operated through GBP. (A) IVCE-MDCT on the axial plane showing dilated small bowel loops located in the left upper quadrant (arrows) and adjacent to the proximal gastrojejunal anastomosis (asterisk). (B) IVCE-MDCT on the coronal plane showing dilated bowel loops in a cephalic position with respect to the transverse colon (asterisk). (C) IVCE-MDCT on the axial plane showing lateralization toward the right side of the distal jejunojejunal anastomosis (asterisk). (D) IVCE-MDCT on the sagittal plane showing twisted mesenteric vessels (circle) accompanied by bowel obstruction in another patient with an internal hernia.</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 2560 "Ancho" => 962 "Tamanyo" => 311108 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Ulcer adjacent to the proximal gastrojejunal anastomosis in a patient operated through GBP. (A) Simple X-ray with oral contrast conducted in a BS showing a reduced caliber of the gastrojejunal anastomosis and an image of the addition of contrast in relation to an ulcer (asterisk). (B) IVCE-MDCT on the axial plane showing increased fat density adjacent to the surgical clip (asterisk) in another patient operated through GBP in relation to an ulcer adjacent to the proximal gastrojejunal anastomosis.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">SD: standard deviation; GBP: gastric bypass procedure; SG: sleeve gastrectomy procedure; BMI: body mass index; R: reconversion; TC: computed tomography scan.</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">The data are expressed as frequencies (row percentages), or averages (standard deviation)</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients with complications<br>(n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>22) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients without complications<br>(n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>133) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Sex, n (%)</span></td><td class="td" title="table-entry " align="char" valign="top">0.0098 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (25%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 (75%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>107) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (9.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97 (90.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age, average (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.6 (11.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.6 (10.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0960 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Weight, average (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">139 (33.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129.8 (25.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2360 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">BMI, average (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.6 (11.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.4 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1887 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Surgical technique, n (%)</span></td><td class="td" title="table-entry " align="char" valign="top">0.6744 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>GBP (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>102) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (14.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87 (85.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SG (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (12.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (87.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>R (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (20%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (80%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Diagnostic method, n (%)</span></td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CT scan (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (47.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (52.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (4.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (95.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>None (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1704397.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Complications based on the demographic characteristics, surgical technique used, and diagnostic method (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>155).</p>" ] ] 7 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Complications \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Radiologic findings \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Management \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">Early (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16)</td><td class="td" title="table-entry " align="left" valign="top">Intraperitoneal hemorrhage/edema (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hyperdense collection (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4)<br>Hemoperitoneum (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5)<br>Extravasation of contrast if there is active bleeding (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Conservative (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4)<br>Surgical drainage in the presence of hemodynamic instability (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dehiscence of suture (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pneumoperitoneum (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5)<br>Free fluid (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5)<br>Effusion of oral contrast in the surgical anastomosis (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Surgical closure (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bowel obstruction (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dilatation of the digestive tract until the obstruction site (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Conservative (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">External hernia (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Eventration of bowel loops and mesenteric fat (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Herniorrhaphy (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Late (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8)</td><td class="td" title="table-entry " align="left" valign="top">Internal hernia (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Altered disposition of loops and anastomosis (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3)<br>Twisted mesenteric vessels (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2)<br>Dilated bowel loops (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Surgical reduction of the hernia (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bowel perforation (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pneumoperitoneum (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3)<br>Free fluid (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3)<br>Effusion of oral contrast distant to the surgical anastomosis (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Conservative, if the perforation is contained (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1)<br>Surgical closure (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ulcer of the anastomotic mouth (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reticular pattern of mesenteric fat (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1)<br>Image of the administration of oral contrast (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Conservative (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1704396.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Radiologic findings, and management of complications in bariatric surgery.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute abdominal pain in the bariatric surgery patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.D. 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