Bariatric surgery complications

Background

- Rou-en-Y - malabsorptive and restrictive physiology 

- Gastric Sleeve - restrictive

- Biliopancreatic diversion

- Vertical banded gastroplaty - now historical as replaced by LAP band 

Diagnosis

- abdominal pain, food intolerance

- sepsis, abnormal VS

Workup

CT AP - use PO & IV contrast

   - pts often cannot tolerated full 1L of PO contrast

   - sip as much contrast as possible in 3hrs then CT    

   - weight limit of CT scanner often exceeded

   - can use Gastrograffin UGI series instead

UGI series

- beware GI pouch limits on contrast volume

- usefull for perforation, internal hernia, stricture, leak

Complications

Early

1. VTE, PNA, UTI, SBO, etc
2. Roux-Limb Obstruction
   1. NV, abd pain
   2. causes acute Gastric dilation
   3. surgical emergency
   4. IR decompression possible
3. Anastamotic Leak
   1. abdominal exam often non-acute due to habitus
4. Intra-abdominal bleeding
   1. may bleed into GI tract and only visualized on endoscopy

Late

1. UGIB
   1. resuscitate in stanrd fashion
   2. emergent endoscopy
   3. often bleed from staple lines, ulcers
2. Anastomotic Leak or Stricture
   1. progressive inability to tolerate PO
   2. abdominal pain
   3. solids first then liquids
   4. needs UGI then likely endoscopy
3. Marginal Ulcer
   1. epigastric pain and dyspepsia
   2. upper endoscopy
   3. manage with acid suppression
4. Internal hernia
   1. obstructive or nonobstructive
   2. crampy intermitten abd pain radiating to back
   3. can have nl abd exam
   4. may strangulate herniated bowel
   5. w/u CT AP and UGI
   6. CT findings swirl sign, intussuscepted bowel
   7. needs surgery early
5. Nurtitional Complications
   1. consider pts immunosuppressed due to malnourishment
   2. Anemia, neuropathy, fractures, hypercalcemia
   3. Wernickes encephalopathy
   4. Dumping syndrome

Source

Ann Emerg Med. 2006;47:160-166., Tintinalli