Skip to main content
SpringerLink
Log in

Surgical Complications of Weight Loss Surgery

  • Chapter
  • First Online:
The Clinician’s Guide to the Treatment of Obesity

Part of the book series: Endocrine Updates ((ENDO))

  • 1562 Accesses

Abstract

Weight loss surgery has many potential benefits to include significant weight loss and resolution of comorbidities such as type 2 diabetes, hypertension, and hyperlipidemia. Weight loss surgery can help patients live a longer, healthier life. While weight loss surgery is generally safe, complications may occur, and primary care providers need to be aware of these complications. Providers taking care of bariatric patients should know when to refer a patient back to their surgeon for a complication, to include the need for a possible surgical revision. Complications are divided into early and late complications, and are at times specific to the procedure itself, whether an adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass, or a duodenal switch. Intra-abdominal complications include an anastomotic leak, obstruction, hernia, or marginal ulcer. Other complications discussed are psychiatric concerns such as depression, and significant malnutrition that can arise if appropriate postoperative care is not provided. All weight loss surgery patients need lifelong follow-up to look for these complications and to prevent weight regain. Early diagnosis and management of complications is important for a patients’ care, and this chapter serves as a guide for any primary care provider taking care of this patient population.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wee CC, Hamel MB, Apovian CM, et al. Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery. JAMA Surg. 2013;148:264–71.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Finks JF, Kole KL, Yenumula PR, et al. Predicting risk for serious complications with bariatric surgery: results from the michigan bariatric surgery collaborative. Ann Surg. 2011;254:633–40.

    Article  PubMed  Google Scholar 

  3. Fronza JS, Prystowsky JB, Hungness ES, Nagle AP. Revisional bariatric surgery at a single institution. Am J Surg. 2010;200:651–4.

    Article  PubMed  Google Scholar 

  4. Victorzon M. Revisional bariatric surgery by conversion to gastric bypass or sleeve—good short-term outcomes at higher risks. Obes Surg. 2012;22:29–33.

    Article  PubMed  Google Scholar 

  5. Hedberg J, Gustavsson S, Sundbom M. Long-term follow-up in patients undergoing open gastric bypass as a revisional operation for previous failed restrictive procedures. Surg Obes Relat Dis. 2012;8:696–701.

    Article  PubMed  Google Scholar 

  6. DeMaria EJ, Pate V, Warthen M, Winegar DA. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery centers of excellence using the Bariatric outcomes longitudinal database. Surg Obes Relat Dis. 2010;6:347–55.

    Article  PubMed  Google Scholar 

  7. Nelson DW, Blair KS, Martin MJ. Analysis of obesity-related outcomes and bariatric failure rates with the duodenal switch vs gastric bypass for morbid obesity. Arch Surg. 2012;147:847–54.

    Article  PubMed  Google Scholar 

  8. Flum DR, Salem L, Elrod JA, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 2005;294:1903–8.

    Article  CAS  PubMed  Google Scholar 

  9. Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.

    Article  PubMed  Google Scholar 

  10. American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. ASMBS updated position statement on prophylactic measures to reduce the risk of venous thromboembolism in bariatric surgery patients. Surg Obes Relat Dis. 2013;9:493–7.

    Article  Google Scholar 

  11. Masoomi H, Buchberg B, Reavis KM, et al. Factors predictive of venous thromboembolism in bariatric surgery. Am Surg. 2011;77:1403–6.

    PubMed  Google Scholar 

  12. Birkmeyer NJ, Share D, Baser O, et al. Preoperative placement of inferior vena cava filters and outcomes after gastric bypass surgery. Ann Surg. 2010;252:313–8.

    Article  PubMed  Google Scholar 

  13. Lim RB, Blackburn GL, Jones DB. Benchmarking best practices in weight loss surgery. Curr Probl Surg. 2010;47:79–174.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Deitel M, Gagner M, Erickson AL, Crosby RD. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:749–59.

    Article  PubMed  Google Scholar 

  15. Schneider BE, Villegas L, Blackburn GL, et al. Laparoscopic gastric bypass surgery: outcomes. J Laparoendosc Adv Surg Tech A. 2003;13:247–55.

    Article  PubMed  Google Scholar 

  16. Gagner M, Milone L, Yung E, et al. Causes of early mortality after laparoscopic adjustable gastric banding. J Am Coll Surg. 2008;206:664–9.

    Article  PubMed  Google Scholar 

  17. Morino M, Toppino M, Forestieri P, et al. Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry. Ann Surg. 2007;246:1002–7 (discussion 1007–9).

    Article  PubMed  Google Scholar 

  18. Sjostrom L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307:56–65.

    Article  PubMed  Google Scholar 

  19. Escalante-Tattersfield T, Tucker O, Fajnwaks P, et al. Incidence of deep vein thrombosis in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4:126–30.

    Article  PubMed  Google Scholar 

  20. Neligan PJ, Malhotra G, Fraser M, et al. Noninvasive ventilation immediately after extubation improves lung function in morbidly obese patients with obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesth Analg. 2010;110:1360–5.

    Article  PubMed  Google Scholar 

  21. Dixon JB, Schachter LM, O’Brien PE, et al. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. JAMA. 2012;308:1142–9.

    Article  CAS  PubMed  Google Scholar 

  22. Gupta PK, Gupta H, Kaushik M, et al. Predictors of pulmonary complications after bariatric surgery. Surg Obes Relat Dis. 2012;8:574–81.

    Article  PubMed  Google Scholar 

  23. Alamoudi OS. Long-term pulmonary complications after laparoscopic adjustable gastric banding. Obes Surg. 2006;16:1685–8.

    Article  PubMed  Google Scholar 

  24. Avriel A, Warner E, Avinoach E, et al. Major respiratory adverse events after laparascopic gastric banding surgery for morbid obesity. Respir Med. 2012;106:1192–8.

    Article  PubMed  Google Scholar 

  25. Nguyen NT, Stevens CM, Wolfe BM. Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. J Gastrointest Surg. 2003;7(997):1003; discussion 1003.

    Google Scholar 

  26. Fisher BL, Atkinson JD, Cottam D. Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21- or 25-mm circular stapler: a randomized prospective blinded study. Surg Obes Relat Dis. 2007;3:176–9.

    Article  PubMed  Google Scholar 

  27. Lalor PF, Tucker ON, Szomstein S, Rosenthal RJ. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2008;4:33–8.

    Article  PubMed  Google Scholar 

  28. Spivak H, Favretti F. Avoiding postoperative complications with the LAP-BAND system. Am J Surg. 2002;184:31S–7S.

    Article  PubMed  Google Scholar 

  29. O’Brien PE, MacDonald L, Anderson M, et al. Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg. 2013;257:87–94.

    Article  PubMed  Google Scholar 

  30. Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16:1450–6.

    Article  PubMed  Google Scholar 

  31. Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18:648–51.

    Article  PubMed  Google Scholar 

  32. Sugerman HJ, Brewer WH, Shiffman ML, et al. A multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric-bypass-induced rapid weight loss. Am J Surg. 1995;169:91–6; discussion 96–7.

    Article  CAS  PubMed  Google Scholar 

  33. Schirmer B, Erenoglu C, Miller A. Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass. Obes Surg. 2002;12:634–8.

    Article  PubMed  Google Scholar 

  34. Capella RF, Iannace VA, Capella JF. Bowel obstruction after open and laparoscopic gastric bypass surgery for morbid obesity. J Am Coll Surg. 2006;203:328–35.

    Article  PubMed  Google Scholar 

  35. Zainabadi K, Ramanathan R. Intussusception after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17:1619–23.

    Article  PubMed  Google Scholar 

  36. Edwards MA, Grinbaum R, Ellsmere J, et al. Intussusception after Roux-en-Y gastric bypass for morbid obesity: case report and literature review of rare complication. Surg Obes Relat Dis. 2006;2:483–9.

    Article  PubMed  Google Scholar 

  37. Moon RC, Teixeira AF, Ducoin C, et al. Comparison of cholecystectomy cases after Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric banding. Surg Obes Relat Dis. 2013;10(1):64–8.

    Article  PubMed  Google Scholar 

  38. Cirignotta F, Manconi M, Mondini S, et al. Wernicke-korsakoff encephalopathy and polyneuropathy after gastroplasty for morbid obesity: report of a case. Arch Neurol. 2000;57:1356–9.

    Article  CAS  PubMed  Google Scholar 

  39. O’Donnell KB, Simmons M. Early-onset copper deficiency following Roux-en-Y gastric bypass. Nutr Clin Pract. 2011;26:66–9.

    Article  PubMed  Google Scholar 

  40. Davies DJ, Baxter JM, Baxter JN. Nutritional deficiencies after bariatric surgery. Obes Surg. 2007;17:1150–8.

    Article  CAS  PubMed  Google Scholar 

  41. Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract. 2005;20:517–25.

    Article  PubMed  Google Scholar 

  42. King WC, Chen JY, Mitchell JE, et al. Prevalence of alcohol use disorders before and after bariatric surgery. JAMA. 2012;307:2516–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Lier HO, Biringer E, Stubhaug B, Tangen T. Prevalence of psychiatric disorders before and 1 year after bariatric surgery: the role of shame in maintenance of psychiatric disorders in patients undergoing bariatric surgery. Nord J Psychiatry. 2013;67:89–96.

    Article  PubMed  Google Scholar 

  44. Tindle HA, Omalu B, Courcoulas A, et al. Risk of suicide after long-term follow-up from bariatric surgery. Am J Med. 2010;123:1036–42.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Gabert DL, Majumdar SR, Sharma AM, et al. Prevalence and predictors of self-reported sexual abuse in severely obese patients in a population-based bariatric program. J Obes. 2013;2013:374050.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Ikossi DG, Maldonado JR, Hernandez-Boussard T, Eisenberg D. Post-traumatic stress disorder (PTSD) is not a contraindication to gastric bypass in veterans with morbid obesity. Surg Endosc. 2010;24:1892–7.

    Article  PubMed  Google Scholar 

  47. Gumbs A, Duffy A, Bell R. Incidence and management of marginal ulceration after laparoscopic Roux-Y gastric bypass. Surg Obes Relat Dis. 2006;2:460–3.

    Article  PubMed  Google Scholar 

  48. Smith MD, Patterson E, Wahed AS, et al. Thirty-day mortality after bariatric surgery: independently adjudicated causes of death in the longitudinal assessment of bariatric surgery. Obes Surg. 2011;21:1687–92.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Tripler Army Medical Center, 1 Jarrett White Rd, 96859, Honolulu, HI, USA

    Margaret E. Clark MD

  2. Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Road, 96859, Honolulu, HI, USA

    LTC (P) Robert B. Lim MD

  3. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Souheil W. Adra MD

  4. Department of Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Daniel B. Jones MD, MS

Authors
  1. Margaret E. Clark MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. LTC (P) Robert B. Lim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Souheil W. Adra MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel B. Jones MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert B. Lim MD .

Editor information

Editors and Affiliations

  1. Assistant Professor of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA

    Adrienne Youdim

Additional information

Disclaimer: The views expressed in this chapter are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Clark, M., Lim, R., Adra, S., Jones, D. (2015). Surgical Complications of Weight Loss Surgery. In: Youdim, A. (eds) The Clinician’s Guide to the Treatment of Obesity. Endocrine Updates. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2146-1_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-2146-1_11

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2145-4

  • Online ISBN: 978-1-4939-2146-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation