Early major complications after bariatric surgery in the USA, 2003–2014: a systematic review and meta‐analysis

Abstract

The effectiveness of bariatric surgery has been well-studied. However, complications after bariatric surgery have been understudied. This review assesses <30-d major complications associated with bariatric procedures, including anastomotic leak, myocardial infarction and pulmonary embolism. This review included 71 studies conducted in the USA between 2003 and 2014 and 107,874 patients undergoing either gastric bypass, adjustable gastric banding or sleeve gastrectomy, with mean age of 44 years and pre-surgery body mass index of 46.5 kg m . Less than 30-d anastomotic leak rate was 1.15%; myocardial infarction rate was 0.37%; pulmonary embolism rate was 1.17%. Among all patients, mortality rate following anastomotic leak, myocardial infarction and pulmonary embolism was 0.12%, 0.37% and 0.18%, respectively. Among surgical procedures, <30-d after surgery, sleeve gastrectomy (1.21% [95% confidence interval, 0.23-2.19%]) had higher anastomotic leak rate than gastric bypass (1.14% [95% confidence interval, 0.84-1.43%]); gastric bypass had higher rates of myocardial infarction and pulmonary embolism than adjustable gastric banding or sleeve gastrectomy. During the review, we found that the quality of complication reporting is lower than the reporting of other outcomes. In summary, <30-d rates of the three major complications after either one of the procedures range from 0% to 1.55%. Mortality following these complications ranges from 0% to 0.64%. Future studies reporting complications after bariatric surgery should improve their reporting quality.

Outcomes of sleeve gastrectomy in patients older than 60 years: a multicenter matched case-control study.

“…Furthermore, the complication rate was similar between the two age groups in our study. Despite the small sample size and matching procedure, our results may be generalized to the entire population, because similar findings were reported by other studies [25,26]. Importantly, especially among elderly people, perioperative care appears to play a crucial role in improving postoperative outcomes.…”

Metabolic surgery in South Africa: an initial academic hospital experience

“…15,16 In our series we had no anastomotic leaks, but worldwide the risk remains at 0.09% in randomised controlled trials, and 1.14% in observational studies. 17 Our major and minor morbidity rate of 5.3% and 8.8% respectively also compares well to the limited national numbers available. [9][10][11] In the current series, where postoperative endoscopy is performed on indication in symptomatic patients only, no marginal ulceration was noted at follow-up.…”

Postoperative Bleeding Risk after Sleeve Gastrectomy. A Two Techniques of Stapled Line Reinforcement Comparative Study in 4996 Patients

“…In a more recent study conducted by Khoursheed et al and published in 2016, the authors included 664 LSG patients, in whom over sewing the stapled line was the option of choice; among these cases, the postoperative bleeding occurred in 2% of cases and 0,5% required re-operation; moreover one patient necessitated conversion to open surgery. However, the postoperative mortality rate was null (8). These data come to underline once again the efficacy and safety of routine over sewing the stapled line.…”

“…However, it should not be omitted the fact that, especially due to these associated comorbidities, the obese patients submitted to bariatric surgery are in fact very fragile, with high risks of developing early postoperative complications (5)(6)(7). Among the most fearful complications which might be encountered during the early postoperative period, the postoperative hemorrhage as well as gastric leaks are the most frequently reported ones (8). When it comes to the postoperative hemorrhage, it can originate from both the stapled line and from the dissecting area, the overall, the reported incidence of this complication goes up to 2% (9-11) ( Fig.…”