Early Bleeding After Laparoscopic Roux-en-Y Gastric Bypass: Incidence, Risk Factors, and Management — a 21-Year Experience

Abstract

Purpose Morbidity and mortality associated with bariatric surgery are considered low. The aim of this study is to assess the incidence, clinical presentation, risk factors, and management of early postoperative bleeding (POB) after laparoscopic Roux-en-Y gastric by-pass (RYGB). Materials and Methods Retrospective analysis of prospectively collected data of consecutive patients who underwent RYGB in 2 expert bariatric centers between January 1999 and April 2020, with a common bariatric surgeon. Results A total of 2639 patients underwent RYGB and were included in the study. POB occurred in 72 patients (2.7%). Intraluminal bleeding (ILB) was present in 52 (72%) patients and extra-luminal bleeding (ELB) in 20 (28%) patients. POB took place within the first 3 postoperative days in 79% of patients. The most frequent symptom was tachycardia (63%). Abdominal pain was more regularly seen with ILB, compared to ELB (50% vs. 20%, respectively, p = 0.02). Male sex was an independent risk factor of POB on multivariate analysis (p < 0.01). LOS was significantly longer in patients who developed POB (8.3 vs. 3.8 days, p < 0.01). Management was conservative for most cases (68%). Eighteen patients with ILB (35%) and 5 patients with ELB (25%) required reoperation. One patient died from multiorgan failure after staple-line dehiscence of the excluded stomach (mortality 0.04%). Conclusion The incidence of POB is low, yet it is the most frequent postoperative complication after RYGB. Most POB can be managed conservatively while surgical treatment is required for patients with hemodynamic instability or signs of intestinal obstruction due to an intraluminal clot. Graphical abstract

Management of Early Postoperative Bleeding After OAGB: A Single-center Experience

“…In our study, no significant correlation was found between preoperative sex, BMI, diabetes mellitus, or hypertension and bleeding after OAGB. Other studies found a correlation between male sex and early bleeding after RYGB 15 . We did not detect such a correlation.…”

“…This is probably due to the fact that most of our patients were females (70%). The same study found a correlation between postoperative hypertension and early bleeding after OAGB 15 . In our study we could not confirm such a relation.…”

“…The same study found a correlation between postoperative hypertension and early bleeding after OAGB. 15 In our study we could not confirm such a relation. It may be attributed to the careful preoperative blood pressure control and the extra vigilant intraoperative hemostasis in hypertensive patients.…”

“…In our study, pelviabdominal CT was not ordered contrary to what was mentioned in other studies 12–15 . In our plan of management, if conservative management succeeded, there was no need for CT scan.…”

“…Other studies found a correlation between male sex and early bleeding after RYGB. 15 We did not detect such a correlation. This is probably due to the fact that most of our patients were females (70%).…”