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Objective: To determine the factors that influence bleeding during the course of bariatric surgeries. Background: Bariatric surgery is safe with a low percentage of complications compared with other abdominal surgeries. Bleeding is one of the most common complications in surgery for obesity that has the risk of being catastrophic. Methods: The study includes 8,544 cases that underwent bariatric surgery from January 2013 to March 2016 retrospectively, in 4 private institutions. Multiple demographic data were collected: patient characteristics, diseases, medications, surgery type, operative technique, devices, surgeon’s skill, and volume. Results: Bleeding was the most frequent complication that occurred in 122 (1.3%) patients. The Gastric bypass had the highest rate of bleeding (3.05%) of which, 20% were intraoperative bleeding and 80% postoperatively (intra-abdominal in 75%, and intra-luminal in 5%). Simultaneous surgeries, revisional surgeries, stratification of body mass index, stapler line reinforcement, and hospital volume did not affect bleeding occurrence. The determining factors for bleeding were hypertension, chronic lung disease, age >45 years, arrhythmia, and surgeon’s skills. Conclusion: Bleeding after bariatric surgery has a low occurrence. The factors that influence the occurrence of perioperative bleeding in bariatric surgery are: hypertension, chronic lung disease, age >45 years, arrhythmia, and surgeon’s skills.

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HERD is a semi-algorithmic method for creating hierarchical ER diagrams from bottom up. The method is based on packaging operations that are applied in several steps on a given flat ER diagram. The result is a hierarchy of simple and interrelated diagrams (namely ER structures) with external relationships to other such diagrams. This chapter describes the application of HERD method using an example from a hospital domain, and an experiment in which we compare the comprehension of HERD diagrams with flat ER diagrams.

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