Bariatric surgery complications

Background

• Rou-en-Y - malabsorptive and restrictive physiology 
• Gastric Sleeve - restrictive
• Biliopancreatic diversion
• Vertical banded gastroplaty - now historical as replaced by LAP band 
• Lap Band Complications

Clinical Features

• abdominal pain, food intolerance
• sepsis, abnormal VS

Differential Diagnosis

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

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

Diagnosis

• 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

See Also

• Lap Band Complications

Source

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