Bariatric Surgery
Gastrointestinal Complications of Bariatric Surgery: Diagnosis and Therapy

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ABSTRACT

Severe or morbid obesity, with body mass indexes exceeding 35 to 40, are often refractory to all therapies other than surgery. The increasing number of patients undergoing bariatric surgery will result in increasing numbers of patients with gastrointestinal complications. The types of complications vary with type of surgery, whether restrictive, malabsorptive, or both, depending on what anatomical and physiologic changes occur postoperatively. One complication of bariatric surgery (gallstones) is due to weight loss after surgery, not the surgery itself. Based on previous meta-analyses, most of the top 10 complications from bariatric surgery are gastrointestinal: dumping, vitamin/mineral deficiencies, vomiting (and nausea), staple line failure, infection, stenosis (and bowel obstruction), ulceration, bleeding, splenic injury, and perioperative death. Two other gastrointestinal complications of bariatric surgery are indirect consequences of the surgery: bacterial overgrowth and diarrhea. Awareness of the types and frequency of gastrointestinal complications of bariatric surgery allows for timely diagnosis and appropriate therapy. As new surgical, and even endoscopic, procedures to treat obesity are developed, new gastrointestinal complications will need to be recognized.

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.

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