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Anastomotic Leak, Sepsis, Pulmonary Embolism, and Early Hemorrhage: How Do I Diagnose and Manage Early Complications of Bariatric Surgeries and Procedures?

  • Katrin TakenakaEmail author
Chapter

Abstract

Bariatric surgeries have become the second most commonly performed abdominal surgery in the USA. It can be difficult to identify bariatric patients with potentially serious complications because they may not always present with typical signs of severe illness (e.g., peritoneal signs, fever). In these patients, tachycardia should be considered a clue to the presence of significant disease (e.g., dehydration, pulmonary embolus, gastric leak, sepsis). The complications of bariatric procedures may be described as early or late. In addition, some complications can occur following any invasive procedure while others are associated with specific types of bariatric surgeries.

Keywords

Surgical site infection Deep vein thrombosis/pulmonary embolus Postoperative bleeding Anastomotic leak GI obstruction Dumping syndrome Gastric stenosis Esophageal/gastric pouch dilatation Gastric slippage Gastric injury/necrosis Bariatric complications 

References

  1. 1.
    Chen J, Mackenzie J, Zhai Y, O'Loughlin J, Kholer R, Morrow E, Glasgow R, Volckmann E, Ibele A. Preventing return to the emergency department following bariatric surgery. Obes Surg. 2017;27:1986–92.CrossRefGoogle Scholar
  2. 2.
    Macht R, George J, Ameli O, Hess D, Cabral H, Kazis L. Factors associated with bariatric postoperative emergency department visits. Surg Obes Relat Dis. 2016;12:1826–31.CrossRefGoogle Scholar
  3. 3.
    Garg T, Rosas U, Rivas H, Azagury D, Morton JM. National prevalence, causes, and risk factors for bariatric surgery readmissions. Am J Surg. 2016;212:76–80.CrossRefGoogle Scholar
  4. 4.
    Kassir R, Debs T, Tiffet O, Blanc P, Caldwell J, Iannelli A, Gugenheim J. Management of complications following bariatric surgery: summary. Int J Surg. 2014;12:1462–4.CrossRefGoogle Scholar
  5. 5.
    Lewis KD, Takenaka KY, Luber SD. Acute abdominal pain in the bariatric surgery patient. Emerg Med Clin N Am. 2016;34:387–407.CrossRefGoogle Scholar
  6. 6.
    Edwards ED, Jacob BP, Gagner M, Pomp A. Presentation and management of common post-weight loss surgery problems in the emergency department. Ann Emerg Med. 2006;47:160–6.CrossRefGoogle Scholar
  7. 7.
    Ellison SR, Ellison SD. Bariatric surgery: a review of the available procedures and complications for the emergency physician. J Emerg Med. 2008;34:21–32.CrossRefGoogle Scholar
  8. 8.
    Luber SD, Fischer DR, Venkat A. Care of the bariatric surgery patient in the emergency department. J Emerg Med. 2008;34:13–20.CrossRefGoogle Scholar
  9. 9.
    Montavers P, Augustin P, Zapella N, et al. Diagnosis and management of the postoperative surgical and medical complications of bariatric surgery. Anaesth Crit Care Pain Med. 2015;34:45–52.CrossRefGoogle Scholar
  10. 10.
    Montravers P, Guglielminotti J, Zappella N, Desmard M, Muller C, Fournier P, et al. Clinical features and outcome of postoperative peritonitis following bariatric surgery. Obes Surg. 2013;23:1536–44.CrossRefGoogle Scholar
  11. 11.
    Chopra T, Zhao J, Alangaden G, Wood M, Kaye K. Preventing surgical site infections after bariatric surgery: value of perioperative antibiotic regimens. Expert Rev Pharm Outcomes Res. 2010;10(3):317–28.Google Scholar
  12. 12.
    Monkhouse SJ, Morgan JD, Norton SA. Complications of bariatric surgery: presentation and emergency management – a review. Ann R Coll Surg Engl. 2009;91:280–6.CrossRefGoogle Scholar
  13. 13.
    Lehnert B, Moshiri M, Osman S, Khandelwal S, Elojeimy S, Bhargava P, Katz DS. Imaging of complications of common bariatric surgical procedures. Radiol Clin N Am. 2014;52:1071–86.CrossRefGoogle Scholar
  14. 14.
    Contival N, Menahem B, Gautier T, Le Roux Y, Alves A. Guiding the non-bariatric surgeon through complications of bariatric surgery. J Visc Surg. 2017;754:1–14.Google Scholar
  15. 15.
    Heneghan H, Meron-Elder S, Yenumula P, Rogula T, Brethauer S, Schauer P. Incidence and management of bleeding complications after gastric bypass surgery in the morbidly obese. Surg Obes Relat Dis. 2012;8:729–35.CrossRefGoogle Scholar
  16. 16.
    Hussain A, El-Hasani S. Bariatric emergencies: current evidence and strategies of management. World J Emerg Surg. 2013;8:58.CrossRefGoogle Scholar
  17. 17.
    Masoomi H, Kim H, Reavis KM, Mills S, Stamos MJ, Nguyen NT. Analysis of factors predictive of gastrointestinal tract leak in laparoscopic and open gastric bypass. Arch Surg. 2011;146:1048–51.CrossRefGoogle Scholar
  18. 18.
    Committee TACI. ASMBS guideline on the prevention and detection of gastrointestinal leak after gastric bypass including the role of imaging and surgical exploration. Surg Obes Relat Dis. 2009;5:293–6.CrossRefGoogle Scholar
  19. 19.
    Gonzalez R, Nelson LG, Gallagher SF, Murr MM. Anastomotic leaks after laparoscopic gastric bypass. Obes Surg. 2004;14:1299–307.CrossRefGoogle Scholar
  20. 20.
    Wernick B, Jansen M, Noria S, Stawicki SP, El Chaar M. Essential bariatric emergencies for the acute care surgeon. Eur J Trauma Emerg Surg. 2016;42:571–84.CrossRefGoogle Scholar
  21. 21.
    Altieri MS, Wright B, Peredo A, Pryor AD. Common weight loss procedures and their complications. Am J Emerg Med. 2018;36(3):475–479.CrossRefGoogle Scholar
  22. 22.
    Warschkow R, Tarantino I, Folie P, Beutner U, Schmied BM, Bisang P, Schultes B, Thurnheer M. C-reactive protein 2 days after laparoscopic gastric bypass surgery reliably indicates leaks and moderately predicts mortality. J Gastrointest Surg. 2012;16:1128–35.CrossRefGoogle Scholar
  23. 23.
    Chang SH, Freeman NLB, Lee JA, Stoll CR, Calhoun AJ, Eagon JC, Colditz GA. Early major complications after bariatric surgery in the USA, 2003–2014: a systematic review and meta-analysis. Obes Rev. 2018;19(4):529–537.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.McGovern Medical School (part of UT Health/The University of Texas Health Science Center at Houston)HoustonUSA

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