Essential bariatric emergencies for the acute care surgeon
- 339 Downloads
Bariatric surgery is the most effective treatment for morbid obesity. Due to the high volume of weight loss procedures worldwide, the general surgeon will undoubtedly encounter bariatric patients in his or her practice. Liberal use of CT scans, upper endoscopy and barium swallow in this patient population is recommended. Some bariatric complications, such as marginal ulceration and dyspepsia, can be effectively treated non-operatively (e.g., proton pump inhibitors, dietary modification). Failure of conservative management is usually an indication for referral to a bariatric surgery specialist for operative re-intervention. More serious complications, such as perforated marginal ulcer, leak, or bowel obstruction, may require immediate surgical intervention. A high index of suspicion must be maintained for these complications despite “negative” radiographic studies, and diagnostic laparoscopy performed when symptoms fail to improve. Laparoscopic-assisted gastric band complications are usually approached with band deflation and referral to a bariatric surgeon. However, if acute slippage that results in gastric strangulation is suspected, the band should be removed immediately. This manuscript provides a high-level overview of all essential bariatric complications that may be encountered by the acute care surgeon.
KeywordsBariatric surgery Emergency treatment General surgeon Complications Clinical management
Compliance with ethical standards
Conflict of interest
Brian Wernick, Matthew Jansen, Sabrena Noria, Stanislaw P. Stawicki and Maher El Chaar declare that they have no conflict of interest.
This research project was performed in accordance with established ethics principles.
- 7.ASBMS Estimate of Bariatric Surgery Numbers. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers.
- 23.Carrodeguas L, Szomstein S, Soto F, Whipple O, Simpfendorfer C, Gonzalvo JP, et al. Management of gastrogastric fistulas after divided Roux-en-Y gastric bypass surgery for morbid obesity: analysis of 1,292 consecutive patients and review of literature. Surg Obes Relat Dis. 2005;1(5):467–74.CrossRefPubMedGoogle Scholar
- 49.Kawkabani Marchini A, Denys A, Paroz A, Romy S, Suter M, Desmartines N, et al. The four different types of internal hernia occurring after laparascopic Roux-en-Y gastric bypass performed for morbid obesity: are there any multidetector computed tomography (MDCT) features permitting their distinction? Obes Surg. 2011;21(4):506–16.CrossRefPubMedGoogle Scholar
- 52.Leyba JL, Navarrete S, Navarrete Llopis S, Sanchez N, Gamboa A. Laparoscopic technique for hernia reduction and mesenteric defect closure in patients with internal hernia as a postoperative complication of laparoscopic Roux-en-Y gastric bypass. Surg Laparosc Endosc Percutan Tech. 2012;22(4):e182–5.CrossRefPubMedGoogle Scholar
- 62.Livingston EH, Ko CY. Assessing the relative contribution of individual risk factors on surgical outcome for gastric bypass surgery: a baseline probability analysis. J Surg Res. 2002;105(48–52):10.Google Scholar
- 63.Abellán I, López V, Lujan J, Abrisqueta J, Hernández Q, Frutos MD, Parrilla P. Stapling versus hand suture for gastroenteric anastomosis in Roux-en-Y gastric bypass: a randomized clinical trial. Obes Surg. 2015;1–6.Google Scholar
- 69.Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247(3):401–7.CrossRefPubMedGoogle Scholar