Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines

Abstract

Background Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Method A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Conclusions The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting.

Hernia as a Complication of Metabolic Bariatric Surgery

“…Recently, a panel of experts issued a bundle of guidelines, based on the Operative management in Bariatric Acute Abdomen (OBA) Survey outcomes (the OBA guidelines) [48]. Most recommendations are based on low quality of evidence, nevertheless this is one of the first comprehensive attempts and could be utilized as a roadmap for future research and care pathways.…”

“…Henceforth, the majority of published series of explorations for IH have implemented the laparoscopic approach. This is reflected in the recent OBA guidelines as well, which dictate exploratory laparoscopy in the first 24-48 hours in stable patients with abdominal pain and inconclusive clinical and radiological data [48]. Furthermore, exploration should proceed in a systematic distal-to-proximal fashion [ileo-cecal valve→ jejuno-jejunostomy→ mesojejunal space→ Petersen's space→ transverse mesocolon (in cases of retrocolic RYGB)→ remnant stomach] [48].…”

Ultrasound of The Pediatric Gastrointestinal Emergencies

“…A variety of conditions fall under the category of nontraumatic gastrointestinal emergencies, which may include but are not limited to pyloric stenosis, appendicitis, intussusception, and bowel obstruction [2]. Early and precise identification of these ailments is crucial for proper treatment and to avoid possible complications [3]. Traditionally, radiographic imaging, such as plain radiographs and contrast studies, have been used to diagnose pediatric gastrointestinal emergencies.…”

Turismo Bariátrico: Lo barato sale caro

“…Muchos regresan a su país en el postoperatorio inmediato con informes en un idioma extranjero. Esto provoca mayor número de complicaciones y detección más tardía (5) .…”