Annales françaises de médecine d'urgence

, Volume 2, Issue 4, pp 243–252 | Cite as

Urgences chez le patient opéré d’une chirurgie de l’obésité

  • C. Ciangura
  • J. Aron-Wisnewsky
  • C. Poitou-Bernert
  • J. -L. Bouillot
  • A. Basdevant
Mise au Point / Update

Résumé

Le taux de réadmission après chirurgie bariatrique est compris entre 6 et 21 % la première année postopératoire. Ces réadmissions sont précoces pour un tiers d’entre elles, mais peuvent survenir plusieurs années après l’intervention. Les complications chirurgicales, qui dépendent du type d’intervention, comprennent les occlusions (par sténose anastomotique, hernie interne), les accidents infectieux (abcès, perforation, fistule), les hémorragies (sur ligne d’agrafes, ou sur ulcère), les complications de paroi ou du matériel implanté (bascule et migration intragastrique de l’anneau, déconnexion de tubulure). Cinq préoccupations médicales dominent : l’embolie pulmonaire et la défaillance cardiaque en postopératoire précoce, l’anémie par déglobulisation, la déshydratation et les troubles ioniques, et quel que soit le délai après l’intervention, les redoutables carences en vitamines, notamment du groupe B, évoquées devant tout signe neuropsychiatrique ou neurologique, en particulier devant des troubles sensitifs et cérébelleux. Les difficultés diagnostiques sont liées à la corpulence rendant l’examen clinique et les résultats d’imagerie souvent peu contributifs. Deux règles doivent être retenues : 1) toute tachycardie supérieure à 120 /min, toute gêne respiratoire non expliquée par une atteinte cardiorespiratoire, tout sepsis, toute agitation, toute douleur abdominale ou tout vomissement non liés à une erreur diététique, doivent évoquer une complication chirurgicale ; 2) dans ce cas de suspicion de complication chirurgicale (fuite anastomotique ou d’occlusion sur hernie interne), l’avis du chirurgien est rapidement nécessaire pour qu’il décide d’une éventuelle exploration chirurgicale laparoscopique en urgence, dont le délai conditionne le pronostic (nécrose intestinale, décès).

Mots clés

Chirurgie bariatrique Urgence Obésité Court circuit gastrique Anneau gastrique 

Bariatric emergencies after surgery

Abstract

The rate of admission in the emergency department during the first year after bariatric surgery is around 6 and 21%. One third of these emergency admissions occur within the first weeks after surgery, whereas others may happen many years after. The surgical complications depend on the type of surgery, and include: occlusions (anastomotic stenosis, internal hernia), hemorrhage (suture, ulcer), septic problem (abscess, fistula, and perforation), parietal complications or complications of the device (banding move or intragastric migration, tube disjunction). Five medical complications are of most concern: pulmonary embolism and cardiac dysfunction the first days after surgery; anemia because of bleeding; dehydration and ionic troubles; micronutrient deficiencies and particularly group B vitamins that should be suspected once neurologic or neuropsychiatric signs are present. Problems associated with the management of obese patient add to the difficulties of interpretation of symptoms, physical examination and radiologic results during emergency admissions. A bariatric emergency should be suspected if tachycardia is above 120 beats/min with sepsis, dyspnea or agitation, if abdominal pain or vomiting occurred and cannot be explained by diet, and required a surgical consulting. If anastomotic link or occlusion on internal hernia is suspected, explorative surgery should be performed urgently, given prognosis (death and intestine necrosis in particular) depends on timely surgery.

Key words

Bariatric surgery Emergency Gastric bypass Gastroplasty Obesity 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Références

  1. 1.
    Chevallier JM, Paita M, Rodde-Dunet MH, et al (2007) Predictive factors of outcome after gastric banding: a nationwide survey on the role of center activity and patients’ behavior. Ann Surg 246:1034–1039PubMedCrossRefGoogle Scholar
  2. 2.
    Basdevant A, Bouillot JL, Clément K, et al (2011) Médecine et chirurgie de l’obésité. Médecine Sciences Publications. Ed Lavoisier, ParisGoogle Scholar
  3. 3.
    Sjöström L, Peltonen M, Jacobson P, et al (2012) Bariatric surgery and long-term cardiovascular events. JAMA 307:56–65PubMedCrossRefGoogle Scholar
  4. 4.
    www.has-sante.fr (dernier accès le 01/03/2012)
  5. 5.
    Hart CL, Hole DJ, Lawlor DA, Smith GD (2007) Obesity and use of acute hospital services in participants of the Renfrew/Paisley study. J Public Health (Oxf) 29:53–56CrossRefGoogle Scholar
  6. 6.
    Dorman RB, Miller CJ, Leslie DB, et al (2012) Risk for hospital readmission following bariatric surgery. Plos One 7 Mar 7Google Scholar
  7. 7.
    Saunders J, Ballantyne GH, Belsley S, et al (2008) One-year readmission rates at a high volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass. Obes Surg 18:1233–1240PubMedCrossRefGoogle Scholar
  8. 8.
    Kellogg TA, Swan T, Leslie DA, et al (2009) Patterns of readmission and reoperation within 90 days after Roux-en-Y gastric bypass. Surg Obes Relat Dis 5:416–423PubMedCrossRefGoogle Scholar
  9. 9.
    Hayashi SY, Faintuch J, Dias França J, et al (2011) Four-year hospital resource utilization after bariatric surgery: Comparison with clinical and surgical controls. Obes Surg 21:1355–13561PubMedCrossRefGoogle Scholar
  10. 10.
    Mark D Smith, Patterson E, Wahed AS, et al (2011) Thirty-day Mortality After Bariatric Surgery: Independently adjudicated causes of death in the longitudinal assessment of bariatric surgery. Obes Surg 21:1687–1692CrossRefGoogle Scholar
  11. 11.
    Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, Flum DR, Belle SH, King WC, et al (2009) Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 361:445–454PubMedCrossRefGoogle Scholar
  12. 12.
    Hignett S, Griffiths P (2009) Manual handling risks in the bariatric (obese) patient pathway in acute sector, community and ambulance care and treatment. Work 33:175–180PubMedGoogle Scholar
  13. 13.
    Kam J, Taylor D (2010) Obesity significantly increases the difficulty of patient management in the emergency department. Emerg Med Australas 22:316–323PubMedCrossRefGoogle Scholar
  14. 14.
    Luber SD, Fischer DR, Vnekat A (2008) Care of the bariatric surgery patient in emergency department. J Emerg Med 34:13–20PubMedCrossRefGoogle Scholar
  15. 15.
    Tsigos C, Hainer V, Basdevant A, et al (2008) Obesity management task force of the European association for the study of obesity. Management of obesity in adults: European clinical practice guidelines. Obes Facts 1:106–116PubMedCrossRefGoogle Scholar
  16. 16.
    Monkhouse SJ, Morgan JD, Norton SA (2009) Complications of bariatric surgery: presentation and emergency management - a review. Ann R Coll Surg Engl 91: 80–86CrossRefGoogle Scholar
  17. 17.
    Hamdan K, Somers S, Chand M (2011) Management of late postoperative complications of bariatric surgery. Br J Surg 98:1345–1355PubMedCrossRefGoogle Scholar
  18. 18.
    Ellison SR, Ellison SD (2008) Bariatric surgery: a review of the available procedures and complications for the emergency physician. J Emerg Med 34:21–32PubMedCrossRefGoogle Scholar
  19. 19.
    Kirshtein B, Lantsberg, Mizrahi S, Avinoach E (2010) Bariatric emergencies for non-bariatric surgeons: complications of laparoscopic gastric banding. Obes Surg 20:1468–1478PubMedCrossRefGoogle Scholar
  20. 20.
    Greenstein AJ, O’Rourke RW (2011) Abdominal pain after gastric bypass: suspects and solutions. Am J Surgery 201:819–827CrossRefGoogle Scholar
  21. 21.
    Fernandez AZ, Demaria EJ, Tichansky DS, et al (2004) Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg 239:698–702PubMedCrossRefGoogle Scholar
  22. 22.
    Gonzalez R, Sarr MG, Smith CD, et al (2007) Diagnosis and contemporary management of anastomic leaks after gastric bypass for obesity. J Am Coll Surg 204:47–55PubMedCrossRefGoogle Scholar
  23. 23.
    Herron D, Roohipour R (2012) Complications of Roux-en-Y gastric bypass and sleeve gastrectomy. Abdom Imaging Epub Mar 3Google Scholar
  24. 24.
    Maggard MA, Shugarman LR, Suttorp M, et al (2005) Metaanalysis: surgical treatment of obesity. Ann Intern Med 142:547–559PubMedGoogle Scholar
  25. 25.
    Masoomi H, Buchberg B, Reavis KM, et al (2011) Factors predictive of venous thromboembolism in bariatric surgery. AmSurg 77:1403–1406Google Scholar
  26. 26.
    Shankar P, Boylan M, Sriram K (2010) Micronutrient deficiencies after bariatric surgery. Nutrition 26:1031–1037PubMedCrossRefGoogle Scholar
  27. 27.
    Galvin E, Brathen G, Yvashynka A, et al (2010) EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol 17:1408–1418PubMedCrossRefGoogle Scholar
  28. 28.
    Schauer PR, Kashyap SR, Wolski K, et al (2012) Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 26:1567–1571CrossRefGoogle Scholar
  29. 29.
    Mingrone G, Panunzi S, De Gaetano A, et al (2012) Bariatric versus conventional medical therapy for type 2 diabetes. N Engl J Med 26:1577–1585CrossRefGoogle Scholar
  30. 30.
    Padwal RS, Gabr RQ, Sharma AM, et al (2011) Effect of gastric bypass surgery on the absorption and bioavailability of metformin. Diabetes Care 34:1295–1300PubMedCrossRefGoogle Scholar

Copyright information

© Société française de médecine d'urgence and Springer-Verlag France 2012

Authors and Affiliations

  • C. Ciangura
    • 1
  • J. Aron-Wisnewsky
    • 2
    • 3
  • C. Poitou-Bernert
    • 2
    • 3
  • J. -L. Bouillot
    • 4
    • 5
  • A. Basdevant
    • 2
    • 3
  1. 1.Service de diabétologie, hôpital de la Pitié-SalpêtrièreAPHPParis cedex 13France
  2. 2.Service de médecine et nutrition, Hôpital de la Pitié Salpêtrière, APHP, hôpital de la Pitié-SalpêtrièreAPHPParis cedex 13France
  3. 3.Université Pierre et Marie CurieParisFrance
  4. 4.Chirurgie générale, digestive et métabolique, hôpital Ambroise-ParéAPHPBoulogne-Billancourt cedexFrance
  5. 5.Université de Versailles Saint-Quentin-en-YvelinesGuyancourtFrance

Personalised recommendations