Bariatric surgery complications

Weight Loss Surgery Complications

1. Background

2. Presentation

3. Complications - early and late

4. Workup

1. Background - Rou-en-Y - malabsorptive and restrictive physiology

- Gastric Sleeve - restrictive

- Biliopancreatic diversion

- Vertical banded gastroplaty - now historical as replaced by LAP band

2. Presentation

- abdominal pain, food intolerance

- sepsis, abnormal VS

3. Complications

a. Early

VTE, PNA, UTI, SBO, etc

Roux-Limb Obstruction

- NV, abd pain

- causes acute Gastric dilation

- surgical emergency

- IR decompression possible

Anastamotic Leak

- abdominal exam often non-acute due to habitus

Intra-abdominal bleeding

- may bleed into GI tract and only visualized on endoscopy

b. Late

UGIB

- resuscitate in stanrd fashion

- emergent endoscopy

- often bleed from staple lines, ulcers

Anastomotic Leak or Stricture

- progressive inability to tolerate PO

- abdominal pain

- solids first then liquids

- needs UGI then likely endoscopy

Marginal Ulcer

- epigastric pain and dyspepsia

- upper endoscopy

- manage with acid suppression

Internal hernia

- obstructive or nonobstructive

- crampy intermitten abd pain radiating to back

- can have nl abd exam

- may strangulate herniated bowel

- w/u CT AP and UGI

- CT findings swirl sign, intussuscepted bowel

- needs surgery early

Nurtitional Complications

- consider pts immunosuppressed due to malnourishment

- Anemia, neuropathy, fractures, hypercalcemia

- Wernickes encephalopathy

- Dumping syndrome

4. Workup

CT AP - use PO & IV contrast

- pts often cannot tolerated full 1L of PO contrast

- sip as much contrast as possible in 3hrs then CT

- weight limit of CT scanner often exceeded

- can use Gastrograffin UGI series instead

UGI series

- beware GI pouch limits on contrast volume

- usefull for perforation, internal hernia, stricture, leak

Ann Emerg Med. 2006;47:160-166., Tintinalli

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