Complications of Bariatric Surgery: Presentation and Emergency Management – a Review

Abstract

Ann R Coll Surg Engl 2009; 91: 280-286 280Obesity is a world-wide epidemic 1 and is associated with multiple serious co-morbidities, both physical and psychological. Over the last decade, there has been an exponential rise in the number of bariatric procedures being offered, 2 as these have consistently been shown to be the only way to achieve sustainable weight loss and improvement in comorbidities, particularly type II diabetes and hypertension. There are many different surgical operations available to achieve weight loss; the choice of surgery depends on a number of factors, not least the experience of the surgeon and the patient's individual requirements. The predominant operation performed in the UK is the laparoscopic adjustable gastric band (LAGB), which is a purely restrictive procedure. Other procedures incorporate a malabsorptive element and include the Roux-en-Y gastric bypass (RYGB) and the biliopancreatic diversion (with or without duodenal switch; BPD, BPD/DS; Fig. 1A). Other operations include sleeve gastrectomy (Fig. 1B) which can be used as a definitive procedure or as a bridge to further by-pass surgery, and the largely historic vertical banded gastroplasty. All surgery carries some degree of risk and the decision to operate is made after a careful balance of the risks versus the benefits. This particular group of patients often have limited physiological reserves and this, together with their physical size, may make the surgery high-risk. Early detection and appropriate management of complications is crucial to prevent long-term morbidity and mortality.This review highlights the main complications that the general surgeon on-call may encounter as an emergency and illustrates the appropriate management strategies.A full literature search was carried out using PubMED and the Cochrane Library. Relevant international articles published in the last 10 years were assessed. Keywords for search purposes included bariatric, surgery, complications, emergency and management. Band-related complications Dysphagia/band slippageImmediate postoperative dysphagia is seen in some patients following LAGB. This is usually due to excessive perigastric fat resulting in a tightly fitting band or to postoperative oedema. Complete dysphagia, even for saliva, may take up to 10 days to resolve. Postoperative intravenous steroids and a strict nil-by-mouth regimen appear to increase the resolution rate for the oedema and thus hasten recovery. These patients are often in-patients until postoperative dysphagia resolves and so it is late dysphagia that more commonly The prevalence of obesity surgery is increasing rapidly in the UK as demand rises. Consequently, general surgeons on-call may be faced with the complications of such surgery and need to have an understanding about how to manage them, at least initially. Obesity surgery is mainly offered in tertiary centres but patients may present with problems to their local district hospital. This review summarises the main complications that may be encountered. MATERIALS AND M...

Baseline patient profiling and three-year outcome data after metabolic surgery at a South African centre of excellence

“…In addition, the place for routine biopsies postoperatively has not been clarified to date. 74 Cholelithiasis is a common following obesity surgery. Some publications suggest a rate as high as 30%.…”

Overview of bariatric surgery for the physician

“…5,6,9,10,25 Long-term complications include internal hernias, anastomotic stenoses, marginal ulceration, fistulae, diarrhoea, dumping syndrome, gallstones, emotional disorders and nutritional deficiencies. 5,6,13,15,20,[25][26][27] Patients with LAGB can experience port problems, stomal obstruction, band slippage/erosion, pouch dilation, gastro-oesophageal reflux and oesophageal dilation. 5,13,19,25 Malnutrition is a concern with BPD with or without DS.…”

“…5,6,13,15,20,[25][26][27] Patients with LAGB can experience port problems, stomal obstruction, band slippage/erosion, pouch dilation, gastro-oesophageal reflux and oesophageal dilation. 5,13,19,25 Malnutrition is a concern with BPD with or without DS. 1,17 Long-term risks for sleeve gastrectomy are unknown.…”

Blutungskomplikationen in der Adipositaschirurgie

“…Sollte das Problem so nicht nachhaltig lösbar sein, muss eine Bandentfernung und ggf. die Umwandlung in eine andere bariatrische Operation erfolgen [8][9][10].…”