Complications of bariatric surgery<br />A.R. khalaj  M.D. Minimal Invasive Surgery Research Center<br /> university of Ira...
MORTALITY<br />Overall mortality was estimated to be less than 1 percent  Meta-analysis: surgical treatment of obesity.<br...
MORTALITY<br />The introduction of laparoscopic RYGB has been associated with a significant reduction in perioperative mor...
REHOSPITALIZATION RATES<br />the rates of unexpected reoperations ranged from 6 to 9 percent <br />      AU - Santry HP; G...
COMPLICATIONS OF MALABSORPTIVE PROCEDURES <br />Jejunoileal bypass<br />    JIB resulted in high rates of diarrhea, arthri...
COMPLICATIONS OF MALABSORPTIVE PROCEDURES <br />Biliopancreatic diversion and duodenal switch complications <br /> signifi...
Vertical banded gastroplasty<br /> staple line disruption 27-48%, stomalstenosis 20-33%, band erosion  1-7%, GERD, nausea/...
Laparoscopic adjustable gastric band<br />Early complications include acute stomal obstruction 6%, band infection 0.3-9%, ...
Laparoscopic adjustable gastric band<br />Late complications include band erosion 7%, band slippage 2-14% or prolapse, por...
Roux-en-Y gastric bypass<br />Pulmonary embolus    up to 3.3%<br /> Optimal strategies for preventing DVT/PE in the gastri...
Leaks  2 and 3 percent <br />TI - Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients--what have we...
Gastric remnant distension<br />Clinical features include pain, hiccups, left upper quadrant tympany, shoulder pain, abdom...
Marginal ulcers0.6 to 16%<br />  Causes of marginal ulcers include :<br />  Poor tissue perfusion due to tension or ischem...
Cholelithiasis<br />  Without prophylaxis, cholelithiasis develops in as many as 38 percent of patients within six months ...
Wound infection<br />Rates of wound infection are significantly greater with open (10 to 15 percent) than laparoscopic (3 ...
Stomalstenosis6 to 20 percent<br />Endoscopic balloon dilation is usually successful .<br />  Repeat dilation sessions may...
Bleeding <br />   Bleeding after gastric bypass has been described in 0.6 to 4.0 percent of patient<br />Ann Surg 2001 Sep...
Ventral incisional hernia<br /> <br />  Ventral incisional hernias occur with a frequency of 0 to 1.8 percent in laparosco...
Failure to lose weight and weight regain <br />   Progressive noncompliant eating and other behavioral habits .<br />    D...
Metabolic and nutritional derangements<br /> Iron, vitamin B12, and folate. Hyperoxaluria and nephrolithiasis have been re...
Internal hernias<br />  Three potential areas of internal herniation are between: <br />    Mesenteric defect at the jejun...
Postoperative hypoglycemia and<br />   Dumping<br />  A small number of patients develop blackouts and seizures after weig...
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Complications of bariatric surgery - www.iranobesitysociety.org

  1. 1.
  2. 2. Complications of bariatric surgery<br />A.R. khalaj M.D. Minimal Invasive Surgery Research Center<br /> university of Iran<br />
  3. 3. MORTALITY<br />Overall mortality was estimated to be less than 1 percent Meta-analysis: surgical treatment of obesity.<br />AU - Maggard MA; Shugarman LR; Suttorp M; Maglione M; Sugarman HJ; Livingston EH; Nguyen NT; Li Z; Mojica WA; Hilton L; Rhodes S; Morton SC; Shekelle PG<br /> SO - Ann Intern Med 2005 Apr 5;142(7):547-59<br /> increasing mortality was associated with advancing age, male sex, and lower surgeon volume of bariatric procedures Surgical volume impacts bariatric surgery mortality: a case for centers of excellence.<br />AU - Hollenbeak CS; Rogers AM; Barrus B; Wadiwala I; Cooney RN<br />SO - Surgery. 2008 Nov;144(5):736-43. Epub 2008 Jul 21<br />
  4. 4. MORTALITY<br />The introduction of laparoscopic RYGB has been associated with a significant reduction in perioperative mortality.0.17 percent as compared to 0.79 for open RYGB 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data.<br />AU - Lancaster RT; Hutter MM<br />SO - SurgEndosc. 2008 Dec;22(12):2554-63. Epub 2008 Sep 20.<br />
  5. 5. REHOSPITALIZATION RATES<br />the rates of unexpected reoperations ranged from 6 to 9 percent <br /> AU - Santry HP; Gillen DL; Lauderdale DS<br /> SO - JAMA 2005 Oct 19;294(15):1909-17. <br />20, 18, and 15 percent of patients required readmission at one, two, and three years, respectively SO - JAMA 2005 Oct 19;294(15):1918-24.<br />hospitalization in the year prior to surgery of approximately 8 percent. <br />
  6. 6. COMPLICATIONS OF MALABSORPTIVE PROCEDURES <br />Jejunoileal bypass<br /> JIB resulted in high rates of diarrhea, arthritis, hepatic failure, cirrhosis, nephrolithiasis, protein malnutritio and vitamin deficiencies - Am J Med 1978 Mar;64(3):461-75.n, <br />SurgClin North Am 1979; 59:1071.<br />
  7. 7. COMPLICATIONS OF MALABSORPTIVE PROCEDURES <br />Biliopancreatic diversion and duodenal switch complications <br /> significant protein calorie malnutrition, anemia, metabolic bone disease, deficiencies of fat-soluble vitamins and vitamin <br />B12- Gastroenterology 2001 Feb;120(3):669-81. <br />
  8. 8. Vertical banded gastroplasty<br /> staple line disruption 27-48%, stomalstenosis 20-33%, band erosion 1-7%, GERD, nausea/vomiting, marginal ulcers, and weight regain TI - Bariatric surgery. Surgery for weight control in patients with morbid obesity.<br /> AU - Balsiger BM; Murr MM; Poggio JL; Sarr MG<br /> SO - Med Clin North Am 2000 Mar;84(2):477-89.<br />
  9. 9. Laparoscopic adjustable gastric band<br />Early complications include acute stomal obstruction 6%, band infection 0.3-9%, gastric perforation, hemorrhage, bronchopneumonia, and delayed gastric emptying. <br />GastrointestSurg 2003; 7:429. <br />
  10. 10. Laparoscopic adjustable gastric band<br />Late complications include band erosion 7%, band slippage 2-14% or prolapse, port or tubing malfunction, leakage at the port site tubing or band, pouch or esophageal dilatation and esophagitis .<br />SO - Obes Surg 2002 Apr;12(2):254-60<br />
  11. 11. Roux-en-Y gastric bypass<br />Pulmonary embolus up to 3.3%<br /> Optimal strategies for preventing DVT/PE in the gastric bypass setting have not been established. However, most bariatric surgeons use both pneumatic compression devices in conjunction with subcutaneous heparin <br />TI - Current practices in the prophylaxis of venous thromboembolism in bariatric surgery.<br />AU - Wu EC; Barba CA<br />SO - ObesSurg 2000 Feb;10(1):7-13; discussion 14<br />
  12. 12. Leaks  2 and 3 percent <br />TI - Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients--what have we learned?<br /> AU - Higa KD; Boone KB; Ho T<br /> SO - ObesSurg 2000 Dec;10(6):509-13. <br />exploratory surgery should be performed without delay, even if test results are not confirmatory. <br />
  13. 13. Gastric remnant distension<br />Clinical features include pain, hiccups, left upper quadrant tympany, shoulder pain, abdominal distension, tachycardia, or shortness of breath. Radiographic assessment may demonstrate a large gastric air bubble<br /> Treatment consists of emergent operative decompression with a gastrostomy tube or percutaneousgastrostomy<br />TI - Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients.<br />AU - Gagner M; Gentileschi P; de Csepel J; Kini S; Patterson E; Inabnet WB; Herron D; Pomp A<br />SO - ObesSurg 2002 Apr;12(2):254-60.<br />
  14. 14. Marginal ulcers0.6 to 16%<br /> Causes of marginal ulcers include :<br /> Poor tissue perfusion due to tension or ischemia at the anastomosis<br />Presence of foreign material, such as staples or nonabsorbable suture <br />Excess acid exposure in the gastric pouch due to gastrogastric fistulas <br />Nonsteroidalantiinflammatory drug use <br />Helicobacter pylori infection <br />Smoking <br />medical treatment<br />
  15. 15. Cholelithiasis<br /> Without prophylaxis, cholelithiasis develops in as many as 38 percent of patients within six months of surgery, and up to 41 percent of such patients become symptomatic .<br /> Am J Gastroenterol 1991 Aug;86(8):1000-5.<br /> The high frequency of cholelithiasis can be reduced to as low as 2 percent with a six month course of ursodeoxycholic acid (a synthetic bile salt) given prophylactically after surgery .<br />Am J Surg 1995 Jan;169(1):91-6; discussion 96-7.<br />
  16. 16. Wound infection<br />Rates of wound infection are significantly greater with open (10 to 15 percent) than laparoscopic (3 to 4 percent) gastric bypass procedures . <br />SO - Ann Surg 2000 Oct;232(4):515-29<br />The incidence of wound infections can be decreased by perioperative administration of antibiotics (usually cefazolin) .<br />
  17. 17. Stomalstenosis6 to 20 percent<br />Endoscopic balloon dilation is usually successful .<br /> Repeat dilation sessions may be required for some patients <br />[ <br /> The complication rate for dilation is approximately 3 percent <br /> Surgical revision (required in less than 0.05 percent of patients) is reserved for those who have persistent stenosis despite repeated dilations.<br />
  18. 18. Bleeding <br /> Bleeding after gastric bypass has been described in 0.6 to 4.0 percent of patient<br />Ann Surg 2001 Sep;234(3):279-89; discussion 289-91<br /> A higher rate of postoperative gastrointestinal bleeding was observed following laparoscopic versus open GBP in a prospective randomized study <br />Ann Surg 2001 Sep;234(3):279-89; discussion 289-91.<br />
  19. 19. Ventral incisional hernia<br /> <br />  Ventral incisional hernias occur with a frequency of 0 to 1.8 percent in laparoscopic series and as high as 24 percent in open series, underscoring a clear advantage of the laparoscopic approach in this regard<br /> SO - Ann Surg 2001 Sep;234(3):279-89; discussion 289-91.<br />
  20. 20. Failure to lose weight and weight regain <br /> Progressive noncompliant eating and other behavioral habits .<br /> Development of a functional gastrogastric fistula.<br /> Gradual enlargement of the gastric pouch.<br /> Dilation of the gastrojejunalanastomosis.<br />
  21. 21. Metabolic and nutritional derangements<br /> Iron, vitamin B12, and folate. Hyperoxaluria and nephrolithiasis have been reported following roux-en-Y gastric bypass surgery. <br />
  22. 22. Internal hernias<br /> Three potential areas of internal herniation are between: <br /> Mesenteric defect at the jejuno-jejunostomy<br /> The space between the transverse mesocolon and Roux-limb mesentery (Peterson's hernias) <br /> The defect in transverse mesocolon if the Roux-limb is passed retrocolic<br /> Internal hernias have been described in 0 [64] and 5 [73] percent of patients undergoing laparoscopic bariatric surgery. <br /> If a patient is suspected of an internal hernia, urgent surgical exploration is indicated<br />
  23. 23. Postoperative hypoglycemia and<br /> Dumping<br />  A small number of patients develop blackouts and seizures after weight loss surgery due to a severe form of recurrent hyperinsulinemic hypoglycemia . TI - Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery.<br />AU - Service GJ; Thompson GB; Service FJ; Andrews JC; Collazo-Clavell ML; Lloyd RV<br />SO - N Engl J Med 2005 Jul 21;353(3):249-54<br />

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