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29 Laparoscopic Gastric Bypass: Management of Complications

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Minimally Invasive Bariatric Surgery

Abstract

Roux-en-Y gastric bypass (RYGB) remains the gold standard procedure for weight loss surgery. In spite of the technical challenges of this procedure, the incidence of complications has dramatically decreased with surgeons’ experience and the implementation of “Centers of Excellence.” Nevertheless, complications are still described in both the intraoperative and postoperative periods. The widespread use of such procedures requires a thorough knowledge of the possible complications even for the “non-bariatric” general surgeon. Some of the complications, if not recognized and managed expeditiously, can potentially lead to devastating consequences, such as short bowel syndrome, permanent neurological damages, and death.

We describe the most common complications occurring after RYGB with their diagnostic and therapeutic approach.

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Author information

Authors and Affiliations

  1. Department of General Surgery, Cleveland Clinic Florida, The Bariatric and Metabolic Institute, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA

    Emanuele Lo Menzo M.D. & Raul J. Rosenthal M.D., F.A.C.S., F.A.S.M.B.S.

  2. Department of General and Vascular Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA

    Samuel Szomstein M.D.

Authors
  1. Emanuele Lo Menzo M.D.
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  2. Samuel Szomstein M.D.
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  3. Raul J. Rosenthal M.D., F.A.C.S., F.A.S.M.B.S.
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Corresponding author

Correspondence to Emanuele Lo Menzo M.D. .

Editor information

Editors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA

    Stacy A. Brethauer

  2. Cleveland Clinic Lerner College of Medicine, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA

    Philip R. Schauer

  3. Department of Surgery, Health Sciences Center, University of Virginia Health System, Charlottesville, Virginia, USA

    Bruce D. Schirmer

Appendices

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Laproscopic transection of gastro-gastric fistula with oversewing of the gastric remnant and pouch (MOV 1301462 kb)

Review Questions and Answers

Questions

  1. 1.

    Which one of the following is not commonly found in rhabdomyolysis (RML) post gastric bypass?

    1. A.

      Elevated serum creatine phosphokinase (CPK)

    2. B.

      Myoglobinuria

    3. C.

      Anesthesia with propofol

    4. D.

      Female gender

  2. 2.

    Regarding gastroesophageal leak the following is true:

    1. A.

      Tachycardia is invariably present

    2. B.

      Upper GI study is as sensitive as CT scan

    3. C.

      Upper GI study is more specific than CT scan

    4. D.

      Every Gastrojejunal anastomotic leak requires surgical re-intervention

  3. 3.

    A 47-year old woman with a history of laparoscopic gastric bypass 2 years ago presents with intermittent periumbilical pain and vomiting. The CT scan and physical exam are unremarkable. Which is the best next step?

    1. A.

      EGD

    2. B.

      Upper GI

    3. C.

      Diagnostic laparoscopy

    4. D.

      Nutritional consult

Answers

  1. 1.

    D. Male gender, higher BMI (>50 kg/m2), current therapy with statins, operative time >4 h, and the use of propofol injection have been associated with increased incidence of rhabdomyolysis. The diagnosis is both clinical and biochemical (increased CPK levels five times higher than the normal, and the presence of myoglobin in the urine). The treatment is mostly supportive with aggressive fluid resuscitation, correction of electrolytes abnormalities and, sometimes, alkalinization of the urine.

  2. 2.

    C. Although the specificity of the UGI is very high for GJ leaks, its sensitivity is only 20 %. CT scan adds sensitivity to the diagnosis of GJ leaks because of the ability to show not only contrast extravasation and extraluminal collections, but also indirect signs of leak, such as surrounding inflammatory changes, intraabdominal free air, and left pleural effusion.

  3. 3.

    C. Intermittent abdominal pain and vomiting after laparoscopic gastric bypass can be due to either an internal hernia or intussusception. The CT scan can be negative in up to 30 % of cases. The best diagnostic and therapeutic intervention is a diagnostic laparoscopy.

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Menzo, E.L., Szomstein, S., Rosenthal, R.J. (2015). 29 Laparoscopic Gastric Bypass: Management of Complications. In: Brethauer, S., Schauer, P., Schirmer, B. (eds) Minimally Invasive Bariatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1637-5_29

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  • DOI: https://doi.org/10.1007/978-1-4939-1637-5_29

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1636-8

  • Online ISBN: 978-1-4939-1637-5

  • eBook Packages: MedicineMedicine (R0)

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