Bariatric SurgeryGastrointestinal Complications of Bariatric Surgery: Diagnosis and Therapy
Section snippets
Therapies for Obesity
Therapies for obesity can be divided into four groups: behavioral (primarily diet and exercise), drugs, devices, and surgery.
Unfortunately, most behavioral programs are ineffective, few drugs are available, and most devices are experimental, leaving surgery as the most effective current therapy for severe and refractory obesity. The number of surgical procedures, of whatever type, have grown from about 20,000 procedures per year in 1993 to more than 120,000 procedures in 2003.3 Thus, the
Complications of Obesity Surgery
Complications of obesity surgery can be divided into (1) perioperative, involving primarily surgical issues; (2) short term, occurring in the first year and both surgical and weight loss related; and (3) long term, involving some surgical issues, with nutritional and metabolic issues.
The immediate and postoperative complications are primarily related to anastamotic leaks and are discussed in depth elsewhere.
The short-term, first-year complications are related to the effects of weight loss, such
Gastrointestinal Complications of Obesity Surgery: Occurrence, Diagnosis and Therapy
Gastrointestinal complications of obesity surgery can occur at any point in time; since many patients will receive care from physicians other than the original surgeons, an awareness of all the potential complications becomes important.1., 11.
The top ten gastrointestinal complications of obesity surgery are given in Table 2; in addition are issues related to weight loss, bacterial overgrowth, and diarrhea.
Prevention of Gastrointestinal Complications of Bariatric Surgery
A number of recommendation can be made about prevention of complications of bariatric surgery, with an emphasis on the gastrointestinal complications:
- 1.
Patient selection for the optimal patient outcome, for sustained weight loss, for bariatric surgery.
- 2.
Preoperative screening for specific abnormalities, such as gallstones and ulcers, that can be addressed perioperatively.
- 3.
Structured surgical care postoperatively, especially for very high-risk patients, who are best treated in experienced programs.
- 4.
Conclusions
Bariatric surgery for morbid obesity is increasingly performed and will likely increase in frequency in the foreseeable future.
Most complications of bariatric surgery, including gastrointestinal ones, are related to the type of surgery performed and the time passed since the surgery.
Since complications of bariatric surgery are treatable once proper diagnosis is made, all physicians seeing post-bariatric surgery patients need to be aware of potential complications so that diagnosis and therapy
Acknowledgments
The authors thank Ben Boatright for help with reference verification and Cecelia Delbridge and Julia Nicosia for manuscript preparation.
References (22)
- et al.
Are bariatric surgical outcomes worth their cost? A systematic review
J Am Coll Surg
(2005) The state of the art in bariatric surgery for weight loss in the morbidly obese patient
Clin Plast Surg
(2004)- et al.
Temporary gastric electrical stimulation with orally or PEG-placed electrodes in patients with drug refractory gastroparesis
Gastrointest Endosc
(2005) - et al.
Bariatric surgery: a systematic review and meta-analysis
JAMA
(2004) Economic Impact of Obesity in Mississippi by the Numbers
(2005)- et al.
Bariatric surgery for morbid obesity
Obes Surg
(2000) Follow-up of nutritional and metabolic problems after bariatric surgery
Diabetes Care
(2005)- et al.
Is routine cholecystectomy required during laparoscopic gastric bypass
Obes Surg
(2004) - et al.
Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality
Surg Endosc
(2004) - et al.
Gastrointestinal hemorrhage after laparoscopic gastric bypass
Obes Surg
(2004)
Bowel obstruction after laparoscopic Roux-en-Y gastric bypass
Obes Surg
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