Bariatric Surgery Complications
The Article: BARIATRIC SURGERY: A REVIEW OF THE AVAILABLE PROCEDURES AND COMPLICATIONS FOR THE EMERGENCY PHYSICIAN. Stephanie R. Ellison, MD et al. The Jounal of Emergency Medicine. Vol. 34, pp. 21-32, 2008
The Idea: Review of common bariatric procedures and associated complications
Nuts and bolts: There are 2 basic strategies for weight loss procedures; restrictive vs malabsorptive. Some procedures have components of both strategies. Common restrictive techniques include the Lap band (adjustable band gastroplasty), Sleeve gastrectomy. The most common malabsorptive procedure is the Roux-en-Y bypass.
Lap band: restrictive band placed around proximal stomach that connects to port in subcutaneous tissue for band adjustment
Roux-en-Y: Two upper limbs are created which anastomose to mid jejuneum. 1: small stomach pouch anastomosed to proximal jejuneum(G-J) 2: bypassed stomach, duodenum (with biliopancreatic supply), proximal jejuneum, anastomosed to distal jejuneum (J-J)
Procedure Specific Complications:
Gastric band (lap band): Slippage- can cause necrosis of stomach, deflate band(surgeon) and take to OR. Erosion- slow process, seen by endoscopy, may present only as port site infection
Sleeve gastrectomy: staple line leak, bleeding, obstruction
Roux-en- Y: Early Complications: anastomotic leak or bleeding at G-J, J-J sites, staple line leaks at gastic pouch or stomach remnant, stomal obstruction (edema or sticture), stomal or marginal ulcers.
Late complications: internal hernias, which are bowel herniation through mesentery of either or the alimentary or biliopancreatic limb multiple protein and vitamin deficiencies, strictures at any site, dumping syndrome, multiple vitamin and mineral deficiencies.
It is important for emergency physicians to know about the potential complications of bariatric surgery and the emergent diagnosis and management of these complications.