J Korean Soc Radiol.  2013 Jan;68(1):33-41.

Multidetector CT Evaluation of Food Stasis in Remnant Stomach and Body Fat Change after Subtotal Gastrectomy by Laparoscopic versus Open Abdominal Approach

• Park AY
• Yu JS
• Choi SH
• Chung JJ
• Kim JH
• Kim KW

Abstract

PURPOSE
This study aimed to compare the degree of gastric food stasis and following body fat changes after laparoscopic subtotal gastrectomy (LSTG) versus open subtotal gastrectomy (OSTG).
MATERIALS AND METHODS
For 284 consecutive gastric cancer patients who underwent subtotal gastrectomy (213 LSTG and 71 OSTG), the one-year follow-up CT images were reviewed retrospectively. The characteristics of gastric stasis was divided into 5 degrees (0, no residue; 1, small secretion; 2, poorly-defined amorphous food; 3, well-delineated measurable food; 4, bezoar-like food). The residual food volume was calculated for the patients with degree 3 or 4 gastric stasis. Postoperative visceral, subcutaneous, and total fat changes were measured on CT and were correlated with the residual food volume.
RESULTS
The LSTG group showed higher degrees of gastric stasis [degree 3 (LSTG, 15.0%; OSTG, 9.9%), degree 4 (LSTG, 6.5%; OSTG, 2.8%)] (p = 0.072). The mean residual food volume of the LSTG group was larger than that of the OSTG group (13779 cc versus 6295 cc) (p = 0.059). Postoperative abdominal fat change was not significantly different between the 2 groups and was not correlated with the residual food volume.
CONCLUSION
LSTG tends to develop gastric stasis more frequently compared with OSTG, but gastric stasis might hardly affect the postoperative body fat status.

MeSH Terms

Abdominal Fat
Adipose Tissue
Follow-Up Studies
Gastrectomy
Gastric Stump
Gastroparesis
Humans
Multidetector Computed Tomography
Retrospective Studies
Stomach Neoplasms

Figure

• 

  Fig. 1 Characteristics of gastric food residue. A. Degree 1, only small amount of radiolucent mucosal secretion that seems to be just minimal air bubbles (arrowheads) without solid component floating on the fluid. B. Degree 2, poorly defined amorphous food materials that seems to be scattered in the fluid or mixed with the fluid (arrowheads). C. Degree 3, well-delineated measurable food materials that seems to be definite internal solid attenuation with visible boundary (arrowheads). D. Degree 4, bezoar-like solid food materials that seems to be well-formed with mottled gas densities (arrowheads).

• 

  Fig. 2 Abdominal visceral fat (VF) and subcutaneous fat (SF) measurement at the umbilicus level on abdomen cross-sectional CT using Aquarius workstation (TeraRecon, Inc., San Mateo, CA, USA). The VF area (green color) and the SF area (blue color) were automatically calculated by measuring the pixels with the attenuation range from -190 to -30 HU. The total fat area was calculated by adding VF area and SF area.

• 

  Fig. 3 Distribution of gastric residual food characteristics of both groups, LSTG and OSTG. Distribution of the gastric food residue characteristics of LSTG group (A) shows higher incidence of gastric food stasis compared with that of OSTG group (B). Note.-LSTG = laparoscopic subtotal gastrectomy, OSTG = open subtotal gastrectomy

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