Advanced practice: Bariatric surgery complications
Roux-en-Y Gastric Bypass (RYGB) → small gastric pouch created and connected to small intestine
Complications:
Internal Hernia → huge mortality! → bowel can push through defects and become intermittently strangulated → a negative CT does not rule this out, so have a low threshold to admit patients for serial abdominal exams for development of peritonitis +/- possible surgical exploration by bariatric team.
Bleeding → early post-op course from staple line; later in post-operative course from marginal ulcer or PUD → consider GI consult for EGD, start PPI, avoid gastric irritants like NSAIDS and Aspirin in all bariatric patients.
Anastomotic Leak → #1 cause of death in these patients, usually occurs in first 24h but can occur days out or even longer → the most sensitive finding for leak is sustained tachycardia and any abnormal vital sign is anastomotic leak until proven otherwise → CT scan not sensitive enough to rule out leak, often taken to OR for revision.
Pulmonary Embolism → #2 cause of death in post-bariatric patients, have a low threshold to add a CT chest along with CT A/P w/ IV and PO contrast.
Biliary Disease → rapid weight loss increases promotion of bile, ursodiol reduces risk.
SBO → not your typical SBO that gets NGT and bowel rest → SBO could be secondary internal hernia not seen on CT scan. Don’t forget about other causes of acute abdomen.
Dumping Syndrome → often in setting of high carb ingestion that leads to electrolyte imbalance and possibly hypoglycemia 2-3h after meal secondary to insulin response → diet modification essential to prevent.
Nutritional Deficiencies
- Fat soluble (ADEK) Vitamins can be deficient.
- Wernicke’s Encephalopathy from Thiamine deficiency.
References:
Hussain A, El-Hasani S. Bariatric emergencies: current evidence and strategies of management. World J Emerg Surgery 2013: 8(1).