Thoracic Complications of Bariatric Surgeries: Overlooked Entities

  • Yasser AljehaniEmail author
  • Abdullah Saleh AlQattan
  • Feras Ahmed Alkuwaiti
  • Farah Alsaif
  • Ibrahim Aldossari
  • Hatem Elbawab
Original Contributions



Bariatric surgeries are increasingly performed to treat obesity worldwide. The currently available literature on these surgeries mainly focuses on their abdominal complications, giving less attention to their thoracic ones. Hence, the present work aimed to highlight the thoracic complications associated with bariatric surgeries.


A retrospective descriptive study was performed and involved the review of the medical charts of 390 patients who underwent different bariatric surgeries between January 2014 and January 2017 in our hospital or who were referred to us from other centers after their specific operations. The data of patients who developed thoracic complications and who required further intervention were identified and categorized by the modality of diagnosis, outcome, duration of hospital and ICU stays, and management. Patients with a history of a preexisting pulmonary disease were excluded.


Twenty-six patients were observed to have thoracic complications secondary to their bariatric surgeries. Twenty-two patients (84.6%) received post-laparoscopic sleeve gastrectomy (LASG). Nine patients (34.6%) required ICU stays. Twenty patients (76.9) had incidences of pleural effusion in the postoperative period. The mean duration of hospital and ICU stays were 4.4 ± 11.67 days and 15 ± 19.36 days, respectively. Other reported thoracic complications included esophageal perforations, thoracic empyema, septic pericardial effusion, and pancreaticopleural fistula.


Bariatric surgeries are safe procedures in selected patients. There is a significant amount of literature describing abdominal, nutritional, neurological, and even ophthalmic complications after bariatric surgeries. Being that they are relatively rare, thoracic complications are underreported in the literature. The management of thoracic complications after bariatric surgery requires awareness and a high index of suspicion to prevent further morbidities and mortalities.


Bariatric surgery Esophageal perforation Empyema Pleural effusion Thoracic complication Obesity 


Compliance with Ethical Standards

This study has been approved by the ethical committee of The Institutional Review Board (IRB-2018-01-250)

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Does not apply.


  1. 1.
    Seidell JC, Halberstadt J. The global burden of obesity and the challenges of prevention. Ann Nutr Metab. 2015;66(Suppl. 2:7–12.CrossRefGoogle Scholar
  2. 2.
    DeNicola E, Aburizaiza OS, Siddique A, et al. Obesity and public health in the Kingdom of Saudi Arabia. Rev Environ Health. 2015;30(3):191–205.CrossRefGoogle Scholar
  3. 3.
    World Health Organization. Global Health risks: mortality and burden of disease attributable to selected major risks. Geneva: World Health Organization; 2009.Google Scholar
  4. 4.
    Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8:CD003641.Google Scholar
  5. 5.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.CrossRefGoogle Scholar
  6. 6.
    Kassir R, Debs T, Blanc P, et al. Complications of bariatric surgery: presentation and emergency management. Int J Surg. 2016;27:77–81.CrossRefGoogle Scholar
  7. 7.
    Schulman AR, Thompson CC. Complications of bariatric surgery: what you can expect to see in your GI practice. Am J Gastroenterol. 2017;112(11):1640–55.CrossRefGoogle Scholar
  8. 8.
    Galgano SJ, Sonavane SK, Sanyal R, et al. Thoracic imaging after bariatric surgery. J Thorac Imaging. 2017;32(5):45–53.CrossRefGoogle Scholar
  9. 9.
    Light RW, George RB. Incidence and significance of pleural effusion after abdominal surgery. Chest. 1976;69(5):621–5.CrossRefGoogle Scholar
  10. 10.
    Cobanoglu U. Pleural effusion resultant after upper abdominal surgery; analysis of 47 cases. J Clin Anal Med. 2011;2(25):16–20.CrossRefGoogle Scholar
  11. 11.
    Nielsen PH, Jepsen SB, Olsen AD. Postoperative pleural effusion following upper abdominal surgery. Chest. 1989;96(5):1133–5.CrossRefGoogle Scholar
  12. 12.
    Biancari F, Saarnio J, Mennander A, et al. Outcome of patients with esophageal perforations: a multicenter study. World J Surg. 2014;38:902–9.CrossRefGoogle Scholar
  13. 13.
    Nijhof HW, Steenvoorde P, Tollenaar RAEM. Perforation of the esophagus caused by the insertion of an intragastric balloon for the treatment of obesity. Obes Surg. 2006;16(5):667–70.CrossRefGoogle Scholar
  14. 14.
    Ruiz D, Vranas K, Robinson DA, et al. Esophageal perforation after gastric balloon extraction. Obes Surg. 2009;19(2):257–60.CrossRefGoogle Scholar
  15. 15.
    Papadimitriou G, Vardas K, Kyriakopoulos G, et al. Esophageal perforation during laparoscopic adjustable gastric band: conversion to open sleeve gastrectomy and endoscopic stent placement. G Chir. 2015;36(2):70.Google Scholar
  16. 16.
    Theodorou D, Doulami G, Larentzakis A, et al. Bougie insertion: a common practice with underestimated dangers. Int J Surg Case Rep. 2012;3:74–7.CrossRefGoogle Scholar
  17. 17.
    Rahman U, Docimo S, Pryor AD, et al. Routine contrast imaging after bariatric surgery and the effect on hospital length of stay. Surg Obes Relat Dis. 2018;14(4):517–20.CrossRefGoogle Scholar
  18. 18.
    Chirica M, Champault A, Dray X, et al. Esophageal perforations. J Visc Surg. 2010;147(3):117–28.CrossRefGoogle Scholar
  19. 19.
    Richardson JD. Management of esophageal perforations: the value of aggressive surgical treatment. Am J Surg. 2005;190:161–5.CrossRefGoogle Scholar
  20. 20.
    Khoursheed MA, Al-Bader IA, Al-asfar FS, et al. Revision of failed bariatric procedures to Roux-en-Y gastric bypass (RYGB). Obes Surg. 2011;21:1157–60.CrossRefGoogle Scholar
  21. 21.
    Krassas A, Mallios D, Boulia S, et al. Thoracic empyema after laparoscopic adjustable gastric banding. A rare complication. Obes Surg. 2010;20(10):1459–61.CrossRefGoogle Scholar
  22. 22.
    Avriel A, Warner E, Avinoach E, et al. Major respiratory adverse events after laparoscopic gastric banding surgery for morbid obesity. Respir Med. 2012;106(8):1192–8.CrossRefGoogle Scholar
  23. 23.
    Rudd AA, Lall C, Deodhar A, et al. Gastropericardial fistula as a late complication of laparoscopic gastric banding. J Clin Imaging Sci. 2017;7:3.CrossRefGoogle Scholar
  24. 24.
    Altasan T, Aljehani Y, Almalki A, et al. Pancreaticopleural fistula: an overlooked entity. Asian Cardiovasc Thorac Ann. 2014;22(1):98–101.CrossRefGoogle Scholar
  25. 25.
    Aljehani Y, Alqattan A, Alismail M. A management dilemma of pancreaticopleural fistula in the era of bariatric surgery. Chirurgia. 2019;32:45–7.CrossRefGoogle Scholar
  26. 26.
    Turcu F, Iordache N. ERCP after bariatric surgery--literature review and case report. J Med Life. 2014;7(3):339–42.Google Scholar
  27. 27.
    Al-Khaldi YM. Bariatric surgery in Saudi Arabia: the urgent need for standards. Saudi J Obesity. 2016;4:1.CrossRefGoogle Scholar
  28. 28.
    Ministry of Health. Healthcare Licensing Services; 2019. Available from: Accessed 25 March 2019.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of the University, College of MedicineImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia

Personalised recommendations