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| ==Roux-en-Y gastric bypass==
| | #REDIRECT[[Bariatric surgery complications]] |
| *Creation of a small gastric pouch and an anastomosis to the jejunum
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| *'''Gastric remnant distension'''<ref>Lee S, Carmody B, Wolfe L, Demaria E, Kellum JM, Sugerman H, Maher JW. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3828 gastric bypass cases. J Gastrointest Surg. 2007;11(6):708. </ref>
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| **Remnant is a blind pouch that may become distended with paralytic ileus
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| **Potential rupture → severe peritonitis
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| **3.9% leak rate for RYGB; overall mortality 0.6%
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| **Jejunojejunostomy leak a/w 40% mortality
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| **S/s: pain, hiccups, LUQ tympany, shoulder pain, abd distention
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| **Dx: XR shows large gastric air bubble vs CT
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| **Tx: emergent operative decompression with percutaneous drainage
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| *'''Stomal Stenosis'''
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| **Occurs in 6-20% of RYGB pts
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| **Possibly related to tissue ischemia or tension on GJ anastomosis
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| **Presentation several weeks after surgery
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| **S/s: N/V, dysphagia, GERD, inability to tolerate PO
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| **Dx with endoscopy vs UGI series vs CT
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| *'''Marginal Ulcers'''
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| **Occur in 0.6-16% of RYGB pts
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| **Acid injury to jejunum
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| **Causes: poor perfusion 2/2 tension/ischemia, increase gastric acid exposure, NSAID use, H pylori infection
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| **S/s: Nausea, pain, bleeding +/- perforation
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| **Dx with endoscopy
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| **Patients typically medically managed
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| *'''Cholelithiasis'''
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| **38% of RYGB pts
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| ***Risk reduced to 2% if ursodiol given as post-op ppx
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| ***Some surgeons perform prophylactic cholecystectomy with RYB procedure
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| **Rapid weight loss increases lithogenicity of bile
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| **Dx: U/S or MRCP
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| *'''Hernias'''
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| **Ventral hernias (0-1.8% in lap RYGB)
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| **Internal hernias (0-5%)
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| ***Intermittent and may be difficult to detect via CT
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| ***Suspected may require urgent surgical exploration lest patient has strangulated pathology
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| *'''Dumping Syndrome'''
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| **Occur in up to 50% of pts when high levels of carbohydrates are ingested
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| **Early dumping syndrome
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| ***Hyperosmolality of food → fluid shifts → colicky and pain, diarrhea, nausea, tachycardia
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| ***Tx: Diet modification to avoid high simple sugars
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| **Late dumping syndrome
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| ***Insulin response that leads to hypoglycemia 2-3 hours after meal
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| ***S/s: dizziness, fatigue, diaphoresis, weakness
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| ==Gastric Banding==
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| *Placement of restrictive ring over the gastric cardia near the GE junction
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| *Lowest mortality rate among all bariatric surgeries (0.05% mortality)
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| *'''Stomal Obstruction'''
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| **Early complication; occurs in 14% go GB pts
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| **Typically 2/2 inclusion over excess perigastric fat vs tissue edema vs inappropriate sized band
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| **S/s: N/V, inability to tolerate PO
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| **Dx: UGI series vs CT
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| **If due to edema, may be treated with NG tube decompression until swelling improves
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| ***May require surgical revision if above unsuccessful
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| *'''Port infection'''
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| **0.3-9% of GB patients
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| **a/w band erosion
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| **Tx: Replacement of port if isolated infection vs band if more extensive
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| *'''Band Erosion'''
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| **Up to 7% of GB pts
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| **Erodes through gastric wall 2/2 wall ischemia vs mechanical stress from band
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| **Occurs on average 22 months after surgery
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| **S/s: e/o infection, failure to lose weight, N/V; epigastric pain and hematemesis
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| **Dx: Endoscopy vs CT
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| **Tx: Band removal
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| *'''Band Slippage/gastric prolapse'''
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| **2-14% of pts
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| **Either anterior or posterior prolapse
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| **S/s: Food intolerance, epigastric pain, acid reflux
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| **Dx: Upper GI series vs CT
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| **Tx: Emergent surgery
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| *'''Esophageal dilatation'''
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| **Up to 10% of pts
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| **a/w over-inflated bands or excessive food intake
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| **S/s: Food/saliva intolerance, reflux, epigastric pain
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| **Dx: UGI series vs CT
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| **Tx: Fluid removal from band initially and behavioral modifications
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| *'''Hiatus hernia'''
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| **Results in refractory reflux
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| ==Sleeve gastrectomy==
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| *Creates sleeve out of the stomach and removes portion of greater curvature of stomach
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| *Complication rate 3-24%; mortality 0.39%
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| *'''Bleeding'''
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| **Typically occur from the staple line
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| *'''Stenosis'''
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| **Can lead to gastric outlet obstruction
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| **S/s: Dysphagia, vomiting, dehydration, inability to tolerate PO
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| **Dx: UGI series vs CT
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| **Tx: Endoscopic dilatation vs surgical intervention depending on involvement
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| *'''Gastric leaks'''
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| **Up to 5.3% of pts; most serious complication a/w GB
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| **2/2 poor healing in setting of inadequate blood supply vs weakness at staple line vs gastric-wall heat ischemia from cautery
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| **Tx: surgical repair vs percutaneous drainge/abx/NPO
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| *'''Reflux'''
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| **Common post-op complication
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| **Treated medically initially with eventual RYGB for refractory cases
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| ==References==
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| <references/>
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| *UTD
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