Bariatric emergencies: current evidence and strategies of management

Abstract

BackgroundThe demand for bariatric surgery is increasing and the postoperative complications are seen more frequently. The aim of this paper is to review the current outcomes of bariatric surgery emergencies and to formulate a pathway of safe management.MethodsThe PubMed and Google search for English literatures relevant to emergencies of bariatric surgery was made, 6358 articles were found and 90 papers were selected based on relevance, power of the study, recent papers and laparoscopic workload. The pooled data was collected from these articles that were addressing the complications and emergency treatment of bariatric patients. 830,998 patients were included in this review.ResultsBariatric emergencies were increasingly seen in the Accident and Emergency departments, the serious outcomes were reported following complex operations like gastric bypass but also after gastric band and the causes were technical errors, suboptimal evaluation, failure of effective communication with bariatric teams who performed the initial operation, patients factors, and delay in the presentation. The mortality ranged from 0.14%-2.2% and increased for revisional surgery to 6.5% (p = 0.002). Inspite of this, mortality following bariatric surgery is still less than that of control group of obese patients (p = value 0.01).ConclusionsMost mortality and catastrophic outcomes following bariatric surgery are preventable. The awareness of bariatric emergencies and its effective management are the gold standards for best outcomes. An algorithm is suggested and needs further evaluation.

Outcomes Following Major Emergency Gastric Surgery: the Importance of Specialist Surgeons

“…ROBSON et al (11) demonstrated that introduction of a subspecialised upper and lower gastrointestinal emergency surgical service was associated with a significant decrease in mortality in patients undergoing surgery for peptic ulcer perforation (10.4% vs. 20.3% ; p = 0.02). Recent guidelines proposed for management of bariatric emergencies stress the importance of early involvement of bariatric specialists (12). Our study extends further the domain over which specialist UGI surgeons can be expected to have better outcomes, as our population includes malignant upper gastro intestinal emergencies as well as benign.…”

Do high levels of Amylase following laparoscopic sleeve gastrectomy predict devastating complications?

“…A leak may be the most feared complication when observing a peri-operative Amylase rise, since in two thirds of cases it may lead to sepsis and even to patient's death [18,41], and hence it may be critical to diagnose this complication and treat accordingly. This complication is contributed especially to a long staple line and high intraluminal pressure, and also to ischemia, hematoma formation, and staple mis ring.…”

“…Post-operative suspicion may be proceeding using abdominal CT, with or without a chest CT, or reexploration [42][43][44][45][46][47][48]. Despite gathering information about factors that are associated with an increased risk of a leak, and different ways to reduce this risk that have been offered, due to the heterogeneity of the studies and small statistical power there are still no recommendations of ways to prevent leaks [18,42,43,49].…”

“…LSG has a risk of complications which is around 6.3%, the major complications are 2.4% and declining along the years. Common short-term post-op complications are bleeding occurring in 1.8% of cases, high leaks (near the esophagogastric junction) occurring in 1.1%, stenosis occurring in 0.9% and mortality rate is around 0.33% [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”

Can We Selectively Reduce Appetite for Energy-Dense Foods? An Overview of Pharmacological Strategies for Modification of Food Preference Behavior

“…Also, despite this radical intervention on the digestive system, some patients who underwent this surgery failed to lose weight [ 24 ] or regained weight lost shortly after the operation [ 25 ]. These patients may be subjected, therefore, to the revisional bariatric surgery that increases the risk of postoperative complications [ 26 , 27 ] and mortality [ 28 ]. Other patients with excessive weight, in turn, cannot be qualified for weight-loss operations because of medical contraindications or simply because of their reluctance to take on the risk of surgery.…”