Abstract
Background
Early postoperative hemorrhage is an infrequent complication of both laparoscopic and open Roux-en-Y gastric bypass (RYGBP). The objective of our study is to review the incidence and management of this complication and identify contributing clinical and technical risk factors.
Methods
Over a 3-year period, 1,025 patients underwent RYGBP at our institution. The medical records of patients who required postoperative blood transfusions were reviewed for clinical presentation, diagnostic evaluation and management. These patients were matched for surgical approach (open vs. laparoscopic) in a 1:3 ratio and compared to a random group of patients who underwent RYGBP during the same time period.
Results
Thirty-three patients (3.2%) were diagnosed with postoperative hemorrhage, 17 (51.5%) of which were intraluminal. The incidence of hemorrhage was higher in the laparoscopic group (5.1% vs. 2.4%, p = 0.02). Comparing bleeders to nonbleeders, the average BMI, gender distribution, gastro-jejunostomy anastomotic technique (stapled vs. hand sewn) and the postoperative administration of ketorolac were not significantly different. The bleeding group was older (47.5 vs. 42.8, p = 0.02), had a longer hospital stay (4.9 vs. 3 days, p = 0.0001) and was more likely to have received low molecular weight heparin (LMWH) preoperatively (p = 0.03). Hemorrhage occurred earlier (13.8 vs. 25.9 h, p = 0.039) and was more severe (4.1 vs. 2.3 transfused blood units, p = 0.007) in the patients who required surgical reexploration (n = 9).
Conclusions
A laparoscopic approach and the preoperative administration of LMWH may increase the incidence of early hemorrhage after RYGBP. This complication frequently requires surgical reexploration and significantly prolongs the hospital stay.
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References
Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003;138(9):957–61.
Nguyen NT, Rivers R, Wolfe BM. Early gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg. 2003;13(1):62–5.
Mehran A, Szomstein S, Zundel N, Rosenthal R. Management of acute bleeding after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13(6):842–7.
Awais O, Raftopoulos I, Luketich JD, Courcoulas A. Acute, complete proximal small bowel obstruction after laparoscopic gastric bypass due to intraluminal blood clot formation. Surg Obes Relat Dis. 2005;1(4):418–22; discussion 422–3.
Madan AK, Ternovits CA, Speck KE, Tichansky DS. Inpatient pain medication requirements after laparoscopic gastric bypass. Obes Surg. 2005;15(6):778–81.
Pellis T, Leykin Y, Albano G, et al. Perioperative management and monitoring of a super-obese patient. Obes Surg. 2004;14(10):1423–7.
Kamelgard JI, Kim KA, Atlas G. Combined preemptive and preventive analgesia in morbidly obese patients undergoing open gastric bypass: a pilot study. Surg Obes Relat Dis. 2005;1(1):12–6.
Govindarajan R, Ghosh B, Sathyamoorthy MK, et al. Efficacy of ketorolac in lieu of narcotics in the operative management of laparoscopic surgery for morbid obesity. Surg Obes Relat Dis. 2005;1(6):530–5; discussion 535–6.
Vuilleumier H, Halkic N. Ruptured subcapsular hematoma after laparoscopic cholecystectomy attributed to ketorolac-induced coagulopathy. Surg Endosc. 2003;17(4):659.
Erstad BL, Rappaport WD. Subcapsular hematoma after laparoscopic cholecystectomy, associated with ketorolac administration. Pharmacotherapy. 1994;14(5):613–5.
Sharma S, Chang DW, Koutz C, et al. Incidence of hematoma associated with ketorolac after TRAM flap breast reconstruction. Plast Reconstr Surg. 2001;107(2):352–5.
Oliak D, Ballantyne GH, Weber P, et al. Laparoscopic Roux-en-Y gastric bypass: defining the learning curve. Surg Endosc. 2003;17(3):405–8.
Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232(4):515–29.
Nguyen NT, Longoria M, Chalifoux S, Wilson SE. Gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg. 2004;14(10):1308–12.
Paige JT, Gouda BP, Gaitor-Stampley V, et al. No correlation between anti-factor Xa levels, low-molecular-weight heparin, and bleeding after gastric bypass. Surg Obes Relat Dis. 2007;3(4):469–75.
Karthik S, Grayson AD, McCarron EE, et al. Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay. Ann Thorac Surg. 2004;78(2):527–34; discussion 534.
Moretto M, Mottin CC, Padoin AV, et al. Endoscopic management of bleeding after gastric bypass – a therapeutic alternative. Obes Surg. 2004;14(5):706.
Lee MG, Provost DA, Jones DB. Use of fibrin sealant in laparoscopic gastric bypass for the morbidly obese. Obes Surg. 2004;14(10):1321–6.
Miller KA, Pump A. Use of bioabsorbable staple reinforcement material in gastric bypass: a prospective randomized clinical trial. Surg Obes Relat Dis. 2007;3(4):417–21; discussion 422.
Acknowledgments
Authors would like to thank Jessie Moore APRN, John Courtney MBA, Jack Contessa PhD, and Dorota Kiwak (poster design for the New England Surgical Society meeting).
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None of the five authors has any conflict of interest, or any disclosure to mention.
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Oral presentation and 1st prize winner, Bariatric surgery competition, CTACS meeting, November 2006.
Poster presentation at the New England Surgical Society meeting, September 2007.
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Bakhos, C., Alkhoury, F., Kyriakides, T. et al. Early Postoperative Hemorrhage After Open and Laparoscopic Roux-En-Y Gastric Bypass. OBES SURG 19, 153–157 (2009). https://doi.org/10.1007/s11695-008-9580-1
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DOI: https://doi.org/10.1007/s11695-008-9580-1