Percutaneous gastrostomy for treating dilatation of the bypassed stomach after bariatric surgery for morbid obesity

OBJECTIVE. Retrospective analysis was performed to determine the safety and effectiveness of percutaneous gastrostomy for treating distention of the bypassed stomach after gastric bypass for morbid obesity. MATERIALS AND METHODS. Eight patients with morbid obesity and Roux-en-Y gastric bypass underwent percutaneous radiologic gastrostomy for postoperative decompression of the bypassed stomach. Four patients underwent gastrostomy on the fourth day after surgery: two in the early postoperative period (less than or equal to 30 days after surgery) and two in the late postoperative period (6, 11 months after the procedure). Procedures were performed using combinations of fluoroscopic, CT, and sonographic guidance. T-tacks and a variety of locking pigtail drainage catheters were placed in seven patients. RESULTS. Gastrostomy placement was technically successful in all patients. Seven of eight patients experienced resolution of symptoms. Gastrostomy catheters were in place for a mean of 31 days. Two complications occurred. Periprocedural peritonitis in one patient with underlying small- bowel obstruction required surgical intervention. One wound infection was treated with antibiotics and local wound care. No catheters became dislodged or obstructed. Four patients treated during the early postoperative period had resolution of symptoms after tube placement and recovered uneventfully. Three of four patients presenting during the intermediate or late postoperative periods had temporary resolution of symptoms, but all eventually required surgical intervention. CONCLUSION. In the absence of complete small-bowel obstruction, percutaneous radiologic gastrostomy provides safe and effective decompression of the excluded gastric remnant after Roux-en-Y gastric bypass. Gastrostomy tube placement after the early postoperative period is temporizing, with surgical intervention eventually required.