Complications of bariatric surgery: Presentation and emergency management

Abstract

The epidemic in obesity has led to an increase in number of so called bariatric procedures. Doctors are less comfortable managing an obese patient after bariatric surgery. Peri-operative mortality is less than 1%. The specific feature in the obese patient is that the classical signs of peritoneal irritation are never present as there is no abdominal wall and therefore no guarding or rigidity. Simple post-operative tachycardia in obese patients should be taken seriously as it is a WARNING SIGNAL. The most common complication after surgery is peritonitis due to anastomotic fistula formation. This occurs typically as an early complication within the first 10 days post-operatively and has an incidence of 1-6% after gastric bypass and 3-7% after sleeve gastrectomy. Post-operative malnutrition is extremely rare after restrictive surgery (ring, sleeve gastrectomy) although may occur after malabsorbative surgery (bypass, biliary pancreatic shunt) and is due to the restriction and change in absorption. Prophylactic cholecystectomy is not routinely carried out during the same procedure as the bypass. Superior mesenteric vein thrombosis after bariatric surgery is a diagnosis which should be considered in the presence of any postoperative abdominal pain. Initially a first etiological assessment is performed (measurement of antithrombin III and of protein C and protein S, testing for activated protein C resistance). If the least doubt is present, a medical or surgical consultation should be requested with a specialist practitioner in the management of obese patients as death rates increase with delayed diagnosis.

The Operative management in Bariatric Acute abdomen (OBA) Survey: long-term complications of bariatric surgery and the emergency surgeon’s point of view

“…The most common postoperative complications of bariatric procedures described in literature are summarized in Table 7 [9–16].…”

“…Anastomotic stenosis can cause an obstruction and it usually involves the gastrojejunal anastomosis. It occurs in approximately 12% of patients after bypass and typically develops a month or more after surgery with a peak occurring 50 days after gastric bypass [16, 17].…”

Gastrectomia Vertical e Cirurgia de Bypass Gástrico em Y de Roux: complicações cirúrgicas e metabólicas tardias

“…Sua descoberta e intervenção é mais difícil do que na técnica do BGYR. Diferentes reforços na linha de grampeamento já foram testados, no entanto foram incapazes de conter a ocorrência de fístulas (BENAIGES D, et al, 2015;KASSIR R, et al, 2016).…”

A Comparative Study to Evaluate the Efficacy of Lekhana Basti and Modified Vachadi Gana Basti in Combination with Navaka Guggulu in Sthaulya (Obesity) -A Study Protocol

“…Bariatric surgery carries risks of having short and long-term complications to be an option for patients with Severe Obesity. The most common complication after surgery is peritonitis, herniation, and pulmonary complications [5]. Some of the co-morbidities related to overweight and Obesity include cancers (cancer of breast, endometrial, ovarian, colorectal, oesophageal, kidney, pancreatic, prostate), Coronary artery diseases, type 2 diabetes, arthritis, asthma and also premature morbidity and mortality.…”