Essential bariatric emergencies for the acute care surgeon

Wernick, Brian; Jansen, Mary T.; Noria, Sabrena; Stawicki, Stanislaw P; Chaar, Maher El

doi:10.1007/s00068-015-0621-x

Cited by 24 publications

(19 citation statements)

References 90 publications

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“… 36 Although fundoplication around the band and the pars flaccida technique for placement of the band are thought to reduce the likelihood of band slippage, 37 it may still occur even after these technical precautions are done at the time of band placement. 38 Band slippage presents as a dilated gastric pouch superior to the band. These patients often report symptoms of immediate or delayed vomiting after meals, a feeling of fullness only relieved by vomiting, and occasional pain or irritation in the upper abdomen.…”

Section: Late Complicationsmentioning

confidence: 99%

Early and late complications of bariatric operation

Lim

Beekley

Johnson

et al. 2018

Trauma Surg Acute Care Open

132

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Weight loss surgery is one of the fastest growing segments of the surgical discipline. As with all medical procedures, postoperative complications will occur. Acute care surgeons need to be familiar with the common problems and their management. Although general surgical principles generally apply, diagnoses specific to the various bariatric operations must be considered. There are anatomic considerations which alter management priorities and options for these patients in many instances. These problems present both early or late in the postoperative course. Bariatric operations, in many instances, result in permanent alteration of a patient’s anatomy, which can lead to complications at any time during the course of a patient’s life. Acute care surgeons diagnosing surgical emergencies in postbariatric operation patients must be familiar with the type of surgery performed, as well as the common postbariatric surgical emergencies. In addition, surgeons must not overlook the common causes of an acute surgical abdomen—acute appendicitis, acute diverticulitis, acute pancreatitis, and gallstone disease—for these are still among the most common etiologies of abdominal pathology in these patients.

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Section: Late Complicationsmentioning

confidence: 99%

Early and late complications of bariatric operation

Lim

Beekley

Johnson

et al. 2018

Trauma Surg Acute Care Open

132

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“…Surgery is mandatory in the first 12-24 h, to obtain a good outcome and decrease morbidity and mortality rates. Laparoscopy is considered a safe technique if skills are present and if the patient is hemodynamically stable [163][164][165].…”

Section: Discussion Of Evidencementioning

confidence: 99%

Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines

et al. 2022

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Background Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Method A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Conclusions The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting.

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“…Secondary bariatric surgery was performed with the application of 5 different techniques, but only 3 of them, including biliopancreatic shunting, distal gastric bypass and gastric banding, led to weight loss with a low incidence of complications. Endoluminal interventions and creation of a new Roux loop are not recommended [72]. Endoscopic techniques that are widely used nowadays include Apollo OverStitch (Apollo Endosurgery, Austin, Texas), which is the formation of a fold and reduction of the gastrojejunal anastomosis diameter, and sclerotherapy and OTSC (Over-The-Scope-Clip) clipping, in which special clips are used to reduce the gastrojejunal anastomosis diameter [44].…”

Section: Reviews оглядиmentioning

confidence: 99%

Early and late complications after gastric bypass: A literature review

Nevmerzhytskyi

2021

ЗХ

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Over the last few decades, excess weight and obesity have become a considerable health problem that has a lasting impact on communities worldwide. According to the WHO, about 1.9 billion people over the age of 18 are overweight [32]. Obesity accounted for about 4.7 million premature deaths in 2017. Globally, obesity was associated with an increase in mortality rate from 4.5 % in 1990 to 8 % in 2017 [32]. Bariatric surgery is currently recognized as the most effective treatment option for morbid obesity. Over the past 10 years, gastric bypass surgery has proved more effective than any other surgical methods due to its optimal metabolic effects. The aim of the review is to carry out an analysis of literature data in order to identify main complications after gastric bypass in patients with obesity. The complication rate after bariatric surgery decreased from 10.5 % in 1993 to 7.6 % in 2006 [3]. The mortality rate after bariatric surgery was 0.08 % within 30 days after surgery and 0.31 % after 30 days [13]. According to the BOLD study (2010), for 57,918 bariatric operations, the complication rate was 6,240 (10.77 %) and the mortality rate was 78 (0.135 %), within 30 days after surgery — 0.089 %, within 90 days after surgery — 0.112 %. Roux‑en‑Y Gastric Bypass (RYGB) was carried out in 30,864 cases, and 4,588 (14.87 %) patients developed postoperative complications. Early complications include anastomotic leaks (0 — 5,6 % for laparoscopic approach and 1,6 — 2,6 % — for laparotomy), small bowel obstruction caused by a blood clot (0 — 0,5 %), bleeding from the sutures (1,5 %), and thromboembolic complications (0,2 — 5 %). Late complications include stenosis of the gastrointestinal tract (3 — 27 %), marginal ulceration (MU) — 0,6 — 16 %, an incarcerated Petersen’s space hernia — 2,51 %, perforation of the stomach and small intestine (1 — 2 %), gastrogastric fistula formation — 1,5 — 6,0 %, weight regain (to 17,1 %). Increasing global demand for bariatric surgery as the best option for the management of excess weight and obesity necessitates more detailed investigation of possible complications it may induce. Therefore, further research is required to develop and study new effective methods for prevention and treatment of complications after surgical treatment of patients with morbid obesity.

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Essential bariatric emergencies for the acute care surgeon

Cited by 24 publications

References 90 publications

Early and late complications of bariatric operation

Early and late complications of bariatric operation

Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines

Early and late complications after gastric bypass: A literature review

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