Management of Acute Bleeding after Laparoscopic Roux-en-Y Gastric Bypass

Abstract

The diagnosis and treatment of acute intraluminal bleeding after LRYGBP represents a surgical dilemma, mainly due to the inaccessibility of the bypassed stomach and the jejuno-jejunostomy, as well as the risks associated with early postoperative endoscopy. The presence of large intra-abdominal drains allows for bleeding site localization (intraluminal vs intraabdominal) and for more accurate monitoring of the bleeding rate. Most cases respond to conservative therapy. Failure of conservative management of intraluminal bleeding, however, is more problematic and may require operative intervention. A treatment algorithm is proposed.

Early postoperative anastomotic hemorrhage after gastrectomy for gastric cancer

“…The great majority of studies reporting complications after gastric surgery did not focus on anastomotic hemorrhage. There are some reports dealing with the management of anastomotic bleeding after gastric bypass surgery for severely obese patients to whom antithrombotics were given to prevent deep venous thrombosis [14][15][16][17][18][19], but few reports have dealt with the management of anastomotic hemorrhage following gastrectomy for gastric cancer [10]. Fischer [11] reported a case of bleeding from the anastomosis using a linear stapler after gastrectomy for duodenal ulcer treated by reoperation.…”

Gastrointestinal Hemorrhage after Laparoscopic Gastric Bypass

“…The primary treatment depends on the clinical presentation and the timing of presentation. 7 Hematemesis or bright red blood per rectum suggests the potential origin of bleeding and thus dictates the steps in treatment. Hypotension, tachycardia, pallor and vasoconstriction signify active rapid bleeding requiring urgent intervention.…”

Bleeding after Gastric Bypass Surgery: The Possibility of using of Postoperative Balloon Enteroscopy

“…Bleeding ulcers localized in the remnant stomach, duodenum and in the area of gastroenteroanastomosis could not be visualized with conventional endoscopy. Several diagnosis and treatment techniques are available for such cases, namely, the use of pediatric colonoscope with retrograde insertion through jejunojejunoanastomosis [7,10], Tc-99m labeled erythrocyte scintigraphy [10][11][12], angiography [6,10] percutaneous or laparoscopical gastrostomy followed by endoscope or bronchoscope introduction into the stomach [1,7,10,11] and single or double balloon enteroscopy [1,6,11].…”