Bariatric surgery complications - Revision history

Danbot: Strip excess bold

2026-03-22T09:36:09Z

Strip excess bold

← Older revision		Revision as of 09:36, 22 March 2026
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	===Roux-en-Y gastric bypass===		===Roux-en-Y gastric bypass===
	*Creation of a small gastric pouch and an anastomosis to the jejunum		*Creation of a small gastric pouch and an anastomosis to the jejunum
	*~~'''~~Gastric remnant distention~~'''~~<ref>Lee S, Carmody B, Wolfe L, Demaria E, Kellum JM, Sugerman H, Maher JW. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3828 gastric bypass cases. J Gastrointest Surg. 2007;11(6):708. </ref>		*Gastric remnant distention<ref>Lee S, Carmody B, Wolfe L, Demaria E, Kellum JM, Sugerman H, Maher JW. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3828 gastric bypass cases. J Gastrointest Surg. 2007;11(6):708. </ref>
	**Remnant is a blind pouch that may become distended with paralytic [[ileus]]		**Remnant is a blind pouch that may become distended with paralytic [[ileus]]
	**Potential rupture → severe [[peritonitis]]		**Potential rupture → severe [[peritonitis]]
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	**Diagnosis: XR shows large gastric air bubble vs CT		**Diagnosis: XR shows large gastric air bubble vs CT
	**Treatment: emergent operative decompression with percutaneous drainage		**Treatment: emergent operative decompression with percutaneous drainage
	*~~'''~~Stomal Stenosis~~'''~~		*Stomal Stenosis
	**Occurs in 6-20% of RYGB patients		**Occurs in 6-20% of RYGB patients
	**Possibly related to tissue ischemia or tension on GJ anastomosis		**Possibly related to tissue ischemia or tension on GJ anastomosis
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	**Signs/symptoms: [[nausea/vomiting]], [[dysphagia]], [[GERD]], inability to tolerate PO		**Signs/symptoms: [[nausea/vomiting]], [[dysphagia]], [[GERD]], inability to tolerate PO
	**Diagnose with endoscopy vs UGI series vs CT		**Diagnose with endoscopy vs UGI series vs CT
	*~~'''~~Marginal Ulcers~~'''~~		*Marginal Ulcers
	**Occur in 0.6-16% of RYGB patients		**Occur in 0.6-16% of RYGB patients
	**Acid injury to jejunum		**Acid injury to jejunum
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	**Diagnose with endoscopy		**Diagnose with endoscopy
	**Patients typically medically managed		**Patients typically medically managed
	*~~'''~~[[Cholelithiasis]]~~'''~~		*[[Cholelithiasis]]
	**38% of RYGB patients		**38% of RYGB patients
	***Risk reduced to 2% if [[ursodiol]] given as post-op ppx		***Risk reduced to 2% if [[ursodiol]] given as post-op ppx
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	**Rapid weight loss increases lithogenicity of bile		**Rapid weight loss increases lithogenicity of bile
	**Diagnosis: U/S or MRCP		**Diagnosis: U/S or MRCP
	*~~'''~~[[Hernia]]s~~'''~~		*[[Hernia]]s
	**Ventral hernias (0-1.8% in lap RYGB)		**Ventral hernias (0-1.8% in lap RYGB)
	**Internal hernias (0-5%)		**Internal hernias (0-5%)
	***Intermittent and may be difficult to detect via CT		***Intermittent and may be difficult to detect via CT
	***Suspected may require urgent surgical exploration lest patient has strangulated pathology		***Suspected may require urgent surgical exploration lest patient has strangulated pathology
	*~~'''~~Dumping Syndrome~~'''~~		*Dumping Syndrome
	**Occur in up to 50% of patients when high levels of carbohydrates are ingested		**Occur in up to 50% of patients when high levels of carbohydrates are ingested
	**Early dumping syndrome		**Early dumping syndrome
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	*Placement of restrictive ring over the gastric cardia near the GE junction		*Placement of restrictive ring over the gastric cardia near the GE junction
	*Lowest mortality rate among all bariatric surgeries (0.05% mortality)		*Lowest mortality rate among all bariatric surgeries (0.05% mortality)
	*~~'''~~Stomal Obstruction~~'''~~		*Stomal Obstruction
	**Early complication; occurs in 14% go GB patients		**Early complication; occurs in 14% go GB patients
	**Typically due to inclusion over excess perigastric fat vs tissue edema vs inappropriate sized band		**Typically due to inclusion over excess perigastric fat vs tissue edema vs inappropriate sized band
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	**If due to edema, may be treated with NG tube decompression until swelling improves		**If due to edema, may be treated with NG tube decompression until swelling improves
	***May require surgical revision if above unsuccessful		***May require surgical revision if above unsuccessful
	*~~'''~~Port infection~~'''~~		*Port infection
	**0.3-9% of GB patients		**0.3-9% of GB patients
	**associated with band erosion		**associated with band erosion
	**treatment: Replacement of port if isolated infection vs band if more extensive		**treatment: Replacement of port if isolated infection vs band if more extensive
	*~~'''~~Band Erosion~~'''~~		*Band Erosion
	**Up to 7% of GB patients		**Up to 7% of GB patients
	**Erodes through gastric wall secondary to wall ischemia vs mechanical stress from band		**Erodes through gastric wall secondary to wall ischemia vs mechanical stress from band
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	**Diagnosis: Endoscopy vs CT		**Diagnosis: Endoscopy vs CT
	**Treatment: Band removal		**Treatment: Band removal
	*~~'''~~Band Slippage/gastric prolapse~~'''~~		*Band Slippage/gastric prolapse
	**2-14% of patients		**2-14% of patients
	**Either anterior or posterior prolapse		**Either anterior or posterior prolapse
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	**Diagnosis: Upper GI series vs CT		**Diagnosis: Upper GI series vs CT
	**Treatment: Emergent surgery		**Treatment: Emergent surgery
	*~~'''~~Esophageal dilatation~~'''~~		*Esophageal dilatation
	**Up to 10% of patients		**Up to 10% of patients
	**associated with over-inflated bands or excessive food intake		**associated with over-inflated bands or excessive food intake
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	**Diagnosis: UGI series vs CT		**Diagnosis: UGI series vs CT
	**Treatment: Fluid removal from band initially and behavioral modifications		**Treatment: Fluid removal from band initially and behavioral modifications
	*~~'''~~Hiatus hernia~~'''~~		*Hiatus hernia
	**Results in refractory reflux		**Results in refractory reflux

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	*Creates sleeve out of the stomach and removes portion of greater curvature of stomach		*Creates sleeve out of the stomach and removes portion of greater curvature of stomach
	*Complication rate 3-24%; mortality 0.39%		*Complication rate 3-24%; mortality 0.39%
	*~~'''~~Bleeding~~'''~~		*Bleeding
	**Typically occur from the staple line		**Typically occur from the staple line
	*~~'''~~Stenosis~~'''~~		*Stenosis
	**Can lead to gastric outlet obstruction		**Can lead to gastric outlet obstruction
	**Signs/symptoms: [[Dysphagia]], [[vomiting]], [[dehydration]], inability to tolerate PO		**Signs/symptoms: [[Dysphagia]], [[vomiting]], [[dehydration]], inability to tolerate PO
	**Dx: UGI series vs CT		**Dx: UGI series vs CT
	**treatment: Endoscopic dilatation vs surgical intervention depending on involvement		**treatment: Endoscopic dilatation vs surgical intervention depending on involvement
	*~~'''~~Gastric leaks~~'''~~		*Gastric leaks
	**Up to 5.3% of patients; most serious complication associated with sleeve gastrectomy		**Up to 5.3% of patients; most serious complication associated with sleeve gastrectomy
	**2/2 poor healing in setting of inadequate blood supply vs weakness at staple line vs gastric-wall heat ischemia from cautery		**2/2 poor healing in setting of inadequate blood supply vs weakness at staple line vs gastric-wall heat ischemia from cautery
	**Treatment: surgical repair vs percutaneous drainage/antibiotic/NPO		**Treatment: surgical repair vs percutaneous drainage/antibiotic/NPO
	*~~'''~~Reflux~~'''~~		*Reflux
	**Common post-op complication		**Common post-op complication
	**Treated medically initially with eventual RYGB for refractory cases		**Treated medically initially with eventual RYGB for refractory cases

Hoxbox: /* External Links */

2021-02-08T13:20:11Z

External Links

← Older revision		Revision as of 13:20, 8 February 2021
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	==External Links==		==External Links==
	*[https://www.acep.org/patient-care/beam/#sm.00012tey58gbae0mqhr158eoj1ppp ACEP BEAM (BARIATRIC EXAMINATION, ASSESSMENT, and MANAGEMENT in the Emergency Department Tool)]		*[https://www.acep.org/patient-care/beam/#sm.00012tey58gbae0mqhr158eoj1ppp ACEP BEAM (BARIATRIC EXAMINATION, ASSESSMENT, and MANAGEMENT in the Emergency Department Tool)]
			*Complications of Bariatric Procedures: ED Evaluation and Management from emDocs: http://www.emdocs.net/complications-of-bariatric-procedures-ed-evaluation-and-management/

	==References==		==References==

ClaireLewis at 16:39, 25 October 2019

2019-10-25T16:39:08Z

Show changes

Neil.m.young: /* See Also */

2018-11-08T16:04:28Z

Jonwarren: Links

2018-09-17T06:48:01Z

Links

← Older revision		Revision as of 06:48, 17 September 2018
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	*'''Cholelithiasis'''		*'''Cholelithiasis'''
	**38% of RYGB patients		**38% of RYGB patients
	***Risk reduced to 2% if ursodiol given as post-op ppx		***Risk reduced to 2% if [[ursodiol]] given as post-op ppx
	***Some surgeons perform prophylactic cholecystectomy with RYB procedure		***Some surgeons perform prophylactic cholecystectomy with RYB procedure
	**Rapid weight loss increases lithogenicity of bile		**Rapid weight loss increases lithogenicity of bile

Neil.m.young: Text replacement - " " to ""

2017-01-30T13:56:12Z

Text replacement - "&nbsp" to ""

← Older revision		Revision as of 13:56, 30 January 2017
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	==Background==		==Background==
	*Rou-en-Y - malabsorptive and restrictive physiology~~&nbsp~~;		*Rou-en-Y - malabsorptive and restrictive physiology;
	*Gastric Sleeve - restrictive		*Gastric Sleeve - restrictive
	*Biliopancreatic diversion		*Biliopancreatic diversion
	*Vertical banded gastroplaty - now historical as replaced by LAP band~~&nbsp~~;		*Vertical banded gastroplaty - now historical as replaced by LAP band;
	*[[Lap Band Complications]]		*[[Lap Band Complications]]

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	**causes acute gastric dilation		**causes acute gastric dilation
	**surgical emergency		**surgical emergency
	**IR~~&nbsp~~;decompression possible		**IR;decompression possible
	*Anastamotic Leak		*Anastamotic Leak
	**abdominal exam often non-acute due to habitus		**abdominal exam often non-acute due to habitus

Neil.m.young at 13:09, 30 January 2017

2017-01-30T13:09:49Z

← Older revision		Revision as of 13:09, 30 January 2017
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	*CT AP - use PO & IV contrast		*CT AP - use PO & IV contrast
	**patients often cannot tolerated full 1L of PO contrast		**patients often cannot tolerated full 1L of PO contrast
	**sip as much contrast as possible in 3hrs then CT~~    ~~		**sip as much contrast as possible in 3hrs then CT
	**weight limit of CT scanner often exceeded		**weight limit of CT scanner often exceeded
	**can use Gastrograffin UGI series instead		**can use Gastrograffin UGI series instead

Rossdonaldson1: /* See Also */

2017-01-08T05:49:28Z

ClaireLewis: /* Late */

2016-10-01T02:37:05Z

Late

← Older revision		Revision as of 02:37, 1 October 2016
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	===Late===		===Late===
	*[[ Upper GI bleed]]		*[[ Upper GI bleed]]
	**resuscitate in ~~stanard~~ fashion		**resuscitate in standard fashion
	**emergent endoscopy		**emergent endoscopy
	**often bleed from staple lines, ulcers		**often bleed from staple lines, ulcers
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	**needs UGI then likely endoscopy		**needs UGI then likely endoscopy
	*Marginal Ulcer		*Marginal Ulcer
	**epigastric pain and dyspepsia		**[[epigastric pain]] and dyspepsia
	**upper endoscopy		**upper endoscopy
	**manage with acid suppression		**manage with acid suppression
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	**CT findings: swirl sign, intussuscepted bowel		**CT findings: swirl sign, intussuscepted bowel
	**needs surgery early		**needs surgery early
	*~~Nurtitional~~ Complications		*Nutritional Complications
	**consider patients immunosuppressed due to malnourishment		**consider patients immunosuppressed due to malnourishment
	**Anemia, neuropathy, fractures, hypercalcemia		**[[Anemia]], neuropathy, fractures, [[hypercalcemia]]
	**~~Wernickes~~ encephalopathy		**[[Wernicke's encephalopathy]]
	**Dumping syndrome		**Dumping syndrome

ClaireLewis: /* Specific Surgeries */

2016-09-07T16:05:59Z

Specific Surgeries

← Older revision		Revision as of 16:05, 7 September 2016
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	*Creation of a small gastric pouch and an anastomosis to the jejunum		*Creation of a small gastric pouch and an anastomosis to the jejunum
	*'''Gastric remnant distension'''<ref>Lee S, Carmody B, Wolfe L, Demaria E, Kellum JM, Sugerman H, Maher JW. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3828 gastric bypass cases. J Gastrointest Surg. 2007;11(6):708. </ref>		*'''Gastric remnant distension'''<ref>Lee S, Carmody B, Wolfe L, Demaria E, Kellum JM, Sugerman H, Maher JW. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3828 gastric bypass cases. J Gastrointest Surg. 2007;11(6):708. </ref>
	**Remnant is a blind pouch that may become distended with paralytic ileus		**Remnant is a blind pouch that may become distended with paralytic [[ileus]]
	**Potential rupture → severe peritonitis		**Potential rupture → severe peritonitis
	**3.9% leak rate for RYGB; overall mortality 0.6%		**3.9% leak rate for RYGB; overall mortality 0.6%

← Older revision		Revision as of 05:49, 8 January 2017
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	==See Also==		==See Also==
	*[[Lap Band Complications]]		*[[Lap Band Complications]]
			*[[Acute gastric dilation]]

	==References==		==References==

← Older revision		Revision as of 16:04, 8 November 2018
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	*[[Lap Band Complications]]		*[[Lap Band Complications]]
	*[[Acute gastric dilation]]		*[[Acute gastric dilation]]

			==External Links==
			*[https://www.acep.org/patient-care/beam/#sm.00012tey58gbae0mqhr158eoj1ppp ACEP BEAM (BARIATRIC EXAMINATION, ASSESSMENT, and MANAGEMENT in the Emergency Department Tool)]

	==References==		==References==