Bariatric surgery complications

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Weight Loss Surgery Complications

1. Background 

2. Presentation 

3. Complications - early and late

4. Workup 

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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

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

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