Bariatric surgery, also referred to as weight-loss surgery, helps patients reach and maintain their weight-loss goals by limiting the amount of food the stomach can hold. The most common surgeries performed at Yale Medicine include gastric bypass surgery, which significantly shrinks the stomach size, and minimally invasive laparoscopic surgery, in which an adjustable gastric band is used to constrict the stomach.
To ensure the quality of the surgery, the patient will undergo an imaging procedure after the surgery called a fluoroscopy. In fluoroscopy, the patient drinks a contrast agent, and then a safe, low-dose continuous X-ray is beamed through the patient so a radiologist can clearly see the stomach and immediate surrounding areas. Steffen Huber, MD, a Yale Medicine radiologist, with expertise in body and cardiovascular imaging, says that his team performs multiple post-surgical fluoroscopy studies per week. Our radiology team remains in close contact with our patients' physicians and surgeons, which ensures seamless care.
Who is a candidate for fluoroscopy of bariatric surgery?
“Every patient who receives bariatric surgery receives a follow-up fluoroscopy,” Dr. Huber says. “In many cases, it can be performed on the same day, soon after the surgery.” The patient must be alert enough to swallow the contrast, he says. “If they’re still groggy, or if the surgery was done late in the afternoon, the fluoroscopy might be performed the next morning.”
Why is fluoroscopy of bariatric surgery performed?
“If the patient has had a bypass or part of their stomach removed, then we’re checking to ensure that the sutures are tight and that contrast isn’t leaking into the abdominal cavity,” Dr. Huber says. “If the patient has had surgery to get a gastric band, we’re checking to make sure the band is situated correctly—not too high, not too low—as it can cause complications if it’s not fitted right.”
There are some cases, Dr. Huber says, in which a patient is referred to the department for a pre-surgical evaluation, to make sure he doesn’t have a hiatal hernia or some other abnormality that might complicate the surgery.
“Some patients might, for instance, be experiencing pain or reflux, which could be signs of hiatal hernia, and their physician or surgeon may refer them to us to take a look before being okayed for bariatric surgery,” he says.
What can a patient expect during the procedure?
The first step is for the patient to be positioned in the fluoroscopy machine, typically with the help of the technologist. “If the patient is somewhat drowsy after surgery, they may be allowed to sit or lay semi-upright in the machine, but if the drowsiness has worn off, or if the imaging is being done the next day, the patient will most likely be standing,” Dr. Huber says.
“Once they’re positioned correctly, we have them drink a contrast, which allows us to better see the esophagus and stomach, and we begin to take the images.” The radiologist watches the monitor as the images are being taken.
The typical procedure lasts about five minutes, from start to finish. “If we believe there may be swelling in the area, we might wait a bit after the contrast has been ingested,” Dr. Huber says, “But it’s usually right after the contrast has been swallowed.”
What are the risks and limitations?
Because fluoroscopy involves the safe use of very low-dose X-rays that are focused on the stomach area, there is little risk to the patient. “The fluoroscopy machine actually has a warning that will go off after it has been on a certain length of time,” Dr. Huber says.
He says that the main consideration is that the patient is able to safely swallow the contrast. “This is why we may wait until the next day if a patient is still fairly groggy after the surgery,” he says.
When can a patient expect the results?
“Most of the time, we tell our patients right away the preliminary result of what we’ve seen on the monitor,” Dr. Huber says. Once the patient has left, the team takes another look at it on the higher resolution monitor in the reading room, to be absolutely sure of what they’re seeing.
“If there’s anything unusual, we’ll let the surgeon know,” he says. “If it’s something more serious, like a leak, the patient may have to go back into surgery, but very rare. Mostly what we see is a bit of swelling.”
What makes Yale Medicine’s approach to fluoroscopy for bariatric surgery unique?
Although post-bariatric surgery imaging is a fairly standard procedure, Dr. Huber says that, in addition to using state-of-the-art fluoroscopy machines, his team keeps in close communication with the patient’s physician and surgeon while the patient is being seen in the radiology department.
“At Yale, we want to ensure that the level of care the patient sees is the absolute best they can get anywhere," he says.