|
|
| Line 1: |
Line 1: |
| ==Roux-en-Y gastric bypass==
| | #REDIRECT[[Bariatric surgery complications]] |
| *Creation of a small gastric pouch and an anastomosis to the jejunum
| |
| *'''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>
| |
| **Remnant is a blind pouch that may become distended with paralytic ileus
| |
| **Potential rupture → severe peritonitis
| |
| **3.9% leak rate for RYGB; overall mortality 0.6%
| |
| **Jejunojejunostomy leak a/w 40% mortality
| |
| **S/s: pain, hiccups, LUQ tympany, shoulder pain, abd distention
| |
| **Dx: XR shows large gastric air bubble vs CT
| |
| **Tx: emergent operative decompression with percutaneous drainage
| |
| *'''Stomal Stenosis'''
| |
| **Occurs in 6-20% of RYGB pts
| |
| **Possibly related to tissue ischemia or tension on GJ anastomosis
| |
| **Presentation several weeks after surgery
| |
| **S/s: N/V, dysphagia, GERD, inability to tolerate PO
| |
| **Dx with endoscopy vs UGI series vs CT
| |
| *'''Marginal Ulcers'''
| |
| **Occur in 0.6-16% of RYGB pts
| |
| **Acid injury to jejunum
| |
| **Causes: poor perfusion 2/2 tension/ischemia, increase gastric acid exposure, NSAID use, H pylori infection
| |
| **S/s: Nausea, pain, bleeding +/- perforation
| |
| **Dx with endoscopy
| |
| **Patients typically medically managed
| |
| *'''Cholelithiasis'''
| |
| **38% of RYGB pts
| |
| ***Risk reduced to 2% if ursodiol given as post-op ppx
| |
| ***Some surgeons perform prophylactic cholecystectomy with RYB procedure
| |
| **Rapid weight loss increases lithogenicity of bile
| |
| **Dx: U/S or MRCP
| |
| *'''Hernias'''
| |
| **Ventral hernias (0-1.8% in lap RYGB)
| |
| **Internal hernias (0-5%)
| |
| ***Intermittent and may be difficult to detect via CT
| |
| ***Suspected may require urgent surgical exploration lest patient has strangulated pathology
| |
| *'''Dumping Syndrome'''
| |
| **Occur in up to 50% of pts when high levels of carbohydrates are ingested
| |
| **Early dumping syndrome
| |
| ***Hyperosmolality of food → fluid shifts → colicky and pain, diarrhea, nausea, tachycardia
| |
| ***Tx: Diet modification to avoid high simple sugars
| |
| **Late dumping syndrome
| |
| ***Insulin response that leads to hypoglycemia 2-3 hours after meal
| |
| ***S/s: dizziness, fatigue, diaphoresis, weakness
| |
| | |
| ==Gastric Banding==
| |
| *Placement of restrictive ring over the gastric cardia near the GE junction
| |
| *Lowest mortality rate among all bariatric surgeries (0.05% mortality)
| |
| *'''Stomal Obstruction'''
| |
| **Early complication; occurs in 14% go GB pts
| |
| **Typically 2/2 inclusion over excess perigastric fat vs tissue edema vs inappropriate sized band
| |
| **S/s: N/V, inability to tolerate PO
| |
| **Dx: UGI series vs CT
| |
| **If due to edema, may be treated with NG tube decompression until swelling improves
| |
| ***May require surgical revision if above unsuccessful
| |
| *'''Port infection'''
| |
| **0.3-9% of GB patients
| |
| **a/w band erosion
| |
| **Tx: Replacement of port if isolated infection vs band if more extensive
| |
| *'''Band Erosion'''
| |
| **Up to 7% of GB pts
| |
| **Erodes through gastric wall 2/2 wall ischemia vs mechanical stress from band
| |
| **Occurs on average 22 months after surgery
| |
| **S/s: e/o infection, failure to lose weight, N/V; epigastric pain and hematemesis
| |
| **Dx: Endoscopy vs CT
| |
| **Tx: Band removal
| |
| *'''Band Slippage/gastric prolapse'''
| |
| **2-14% of pts
| |
| **Either anterior or posterior prolapse
| |
| **S/s: Food intolerance, epigastric pain, acid reflux
| |
| **Dx: Upper GI series vs CT
| |
| **Tx: Emergent surgery
| |
| *'''Esophageal dilatation'''
| |
| **Up to 10% of pts
| |
| **a/w over-inflated bands or excessive food intake
| |
| **S/s: Food/saliva intolerance, reflux, epigastric pain
| |
| **Dx: UGI series vs CT
| |
| **Tx: Fluid removal from band initially and behavioral modifications
| |
| *'''Hiatus hernia'''
| |
| **Results in refractory reflux
| |
| | |
| ==Sleeve gastrectomy==
| |
| *Creates sleeve out of the stomach and removes portion of greater curvature of stomach
| |
| *Complication rate 3-24%; mortality 0.39%
| |
| *'''Bleeding'''
| |
| **Typically occur from the staple line
| |
| *'''Stenosis'''
| |
| **Can lead to gastric outlet obstruction
| |
| **S/s: Dysphagia, vomiting, dehydration, inability to tolerate PO
| |
| **Dx: UGI series vs CT
| |
| **Tx: Endoscopic dilatation vs surgical intervention depending on involvement
| |
| *'''Gastric leaks'''
| |
| **Up to 5.3% of pts; most serious complication a/w sleeve gastrectomy
| |
| **2/2 poor healing in setting of inadequate blood supply vs weakness at staple line vs gastric-wall heat ischemia from cautery
| |
| **Tx: surgical repair vs percutaneous drainge/abx/NPO
| |
| *'''Reflux'''
| |
| **Common post-op complication
| |
| **Treated medically initially with eventual RYGB for refractory cases
| |
| | |
| ==References==
| |
| <references/>
| |
| *UTD
| |
