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Obesity Surgery

, Volume 19, Issue 2, pp 153–157 | Cite as

Early Postoperative Hemorrhage After Open and Laparoscopic Roux-En-Y Gastric Bypass

  • Charles BakhosEmail author
  • Fuad Alkhoury
  • Tassos Kyriakides
  • Randolph Reinhold
  • Geoffrey Nadzam
Research Article

Abstract

Background

Early postoperative hemorrhage is an infrequent complication of both laparoscopic and open Roux-en-Y gastric bypass (RYGBP). The objective of our study is to review the incidence and management of this complication and identify contributing clinical and technical risk factors.

Methods

Over a 3-year period, 1,025 patients underwent RYGBP at our institution. The medical records of patients who required postoperative blood transfusions were reviewed for clinical presentation, diagnostic evaluation and management. These patients were matched for surgical approach (open vs. laparoscopic) in a 1:3 ratio and compared to a random group of patients who underwent RYGBP during the same time period.

Results

Thirty-three patients (3.2%) were diagnosed with postoperative hemorrhage, 17 (51.5%) of which were intraluminal. The incidence of hemorrhage was higher in the laparoscopic group (5.1% vs. 2.4%, p = 0.02). Comparing bleeders to nonbleeders, the average BMI, gender distribution, gastro-jejunostomy anastomotic technique (stapled vs. hand sewn) and the postoperative administration of ketorolac were not significantly different. The bleeding group was older (47.5 vs. 42.8, p = 0.02), had a longer hospital stay (4.9 vs. 3 days, p = 0.0001) and was more likely to have received low molecular weight heparin (LMWH) preoperatively (p = 0.03). Hemorrhage occurred earlier (13.8 vs. 25.9 h, p = 0.039) and was more severe (4.1 vs. 2.3 transfused blood units, p = 0.007) in the patients who required surgical reexploration (n = 9).

Conclusions

A laparoscopic approach and the preoperative administration of LMWH may increase the incidence of early hemorrhage after RYGBP. This complication frequently requires surgical reexploration and significantly prolongs the hospital stay.

Keywords

Laparoscopy Morbid obesity Bleeding Ketorolac Heparin 

Notes

Acknowledgments

Authors would like to thank Jessie Moore APRN, John Courtney MBA, Jack Contessa PhD, and Dorota Kiwak (poster design for the New England Surgical Society meeting).

Conflicts of interest

None of the five authors has any conflict of interest, or any disclosure to mention.

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Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Charles Bakhos
    • 1
    Email author
  • Fuad Alkhoury
    • 1
  • Tassos Kyriakides
    • 2
  • Randolph Reinhold
    • 1
  • Geoffrey Nadzam
    • 1
  1. 1.Department of SurgeryHospital of Saint RaphaelNew HavenUSA
  2. 2.Department of Internal MedicineYale University School of MedicineWest HavenUSA

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