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Early Postoperative Bleeding After Laparoscopic Roux-En-Y Gastric Bypass: a Single Center Analysis

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Abstract

Purpose

Early postoperative bleeding is a common complication after laparoscopic Roux-en-Y gastric bypass (LRYGB) and is associated with significant morbidity. We aimed to identify predictors of early postoperative bleeding after LRYGB and characterize hemorrhagic events and 30-day postoperative outcomes.

Material and Methods

We conducted a retrospective cohort study regarding all patients submitted to LRYGB in 2019 at a high-volume obesity center. Early postoperative bleeding was defined as any clinically significant evidence of hemorrhage in the early postoperative period. Demographic, preoperative, and intraoperative factors were evaluated for associations with postoperative bleeding. Postoperative outcomes were compared between patients with and without hemorrhage.

Results

Of 340 patients submitted to LRYGB, 14 (4.1%) had early postoperative bleeding. Patients with bleeding had an increased preoperative left hepatic lobe diameter (8.4 vs. 7.3 cm, p = 0.048). Prior cholecystectomy (28.6 vs. 14.5%) and previous bariatric surgery (35.7 vs. 23.9%) tended to be more prevalent among these patients. Bleeding occurred at a median time of 31.2 [IQR 19.7–38.5] h. Thirteen patients presented with intraluminal bleeding and one with extraluminal bleeding. Melena was the most common symptom. All hemorrhages were clinically diagnosed, and 92.9% were managed conservatively. Postoperative bleeding was associated with longer hospital stay (3.5 vs. 2.0 days), higher reintervention (7.1 vs. 0%), and readmission (14.3 vs. 0%), all p < 0.05.

Conclusions

Bleeding was the most frequent early complication after LRYGB. Patients with hepatomegaly and prior surgeries may have technically challenging LRYGB and should be carefully assessed. Perioperative strategies should be encouraged in high-risk patients to prevent bleeding.

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Acknowledgements

The authors would like to acknowledge all members of the Obesity Integrated Responsibility Unit (CRI-O) group.

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Authors and Affiliations

  1. Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal

    André Pereira, Rui Ferreira Santos, André Costa-Pinho, Alexandre Silva, Jorge Nogueiro, Silvestre Carneiro & Hugo Santos-Sousa

  2. Surgery Department, São João University Medical Center, Porto, Portugal

    André Pereira, Jorge Nogueiro & Silvestre Carneiro

  3. Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Porto, Portugal

    André Costa-Pinho, Eduardo Lima-da-Costa, Hugo Santos-Sousa & John Preto

Authors
  1. André Pereira
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  2. Rui Ferreira Santos
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  3. André Costa-Pinho
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  4. Alexandre Silva
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  7. Eduardo Lima-da-Costa
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  8. Hugo Santos-Sousa
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  9. John Preto
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Corresponding author

Correspondence to André Costa-Pinho.

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Ethics Approval

This study was approved by the Health Ethics Committee of our hospital (deliberation no. 46/2021).

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Informed consent does not apply.

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The authors declare no competing interests.

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Key Points

• Bleeding was the most frequent complication after LRYGB, with an incidence of 4.1%.

• Patients with bleeding had an increased preoperative left hepatic lobe diameter.

• Bleeding was conservatively managed in 92.9% of the patients.

• Bleeding resulted in longer hospital stay, higher reintervention, and readmission.

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Pereira, A., Santos, R.F., Costa-Pinho, A. et al. Early Postoperative Bleeding After Laparoscopic Roux-En-Y Gastric Bypass: a Single Center Analysis. OBES SURG 32, 1902–1908 (2022). https://doi.org/10.1007/s11695-022-05973-6

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  • DOI: https://doi.org/10.1007/s11695-022-05973-6

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