One of the most serious complications of gastric bypass surgery is stomach loss, which can lead to peritonitis. Peritonitis is an inflammation of the peritoneum, the smooth membrane that covers the cavity of the abdomen. A leaking anastomosis can cause bleeding and infection until treated. These leaks are serious and can endanger life.
Long-term complications can include ulcers, scarring, and narrowing of the anastomosis (where the intestine is connected to the gastric pouch), known as stenosis. A drainage path through the skin called a fistula may also develop. A fistula may develop between the gastric pouch and the stomach that has not been inserted. Pneumonia is another dangerous complication, as digestive juices can reach the lungs.
Weight-loss surgery is one of the fastest-growing segments of the surgical discipline. As with all medical procedures, post-operative complications will occur. Intensive care surgeons should be familiar with common problems and their treatment. While general surgical principles generally apply, the specific diagnoses of different bariatric operations should be considered.
There are anatomical considerations that alter priorities and treatment options for these patients in many cases. These problems occur both at the beginning and at the end of the postoperative period. Bariatric operations, in many cases, cause a permanent alteration of the patient's anatomy, which can cause complications at any time in the patient's life. Intensive care surgeons who diagnose surgical emergencies in patients after a bariatric operation should be familiar with the type of surgery performed, as well as with the most common post-bariatric surgical emergencies.
In addition, surgeons should not overlook the common causes of acute abdominal surgery, such as acute appendicitis, acute diverticulitis, acute pancreatitis, and gallstone disease, as these remain one of the most common etiologies of abdominal pathology in patients undergoing bariatric operations. In cases of appendicitis and diverticulitis, a previous bariatric operation may have little impact on treatment plans or clinical outcome. On the contrary, the treatment of pancreatitis and gallstone disease can be significantly affected by the anatomy of the patient resulting from a bariatric operation., which limits the available modalities. Bariatric procedures are generally safe and effective, but they can be associated with devastating complications, some of which can be fatal if not addressed quickly.
Bariatric surgical procedures include sleeve gastrectomies (SG), Roux-en-Y Y-bypass (RYGB), and gastric balloons. Initial complications include leaks, stenoses, bleeding, and venous thromboembolic events (VTE). These principles also apply to bariatric operations that are performed less frequently, such as minigastric bypass, ileal duodenal bypass with single anastomosis, and duodenal switch (DS), also known as shunt biliopancreatic with an SG. In hemodynamically normal patients, evaluation of other causes of postoperative tachycardia, such as postoperative bleeding, hypovolemia, and pneumonia, should precede re-examination.
The evaluation of a leak should include a CT scan of the abdomen with oral contrast medium; patients should be instructed to drink about 100 cc of contrast material just before the scan. Computed tomography can detect other diseases based on the differential diagnosis of tachycardia, such as bleeding and pneumonia. The scintigraphy may be performed in conjunction with a CT lung angiogram to detect a pulmonary ejaculation. The detection rate of leaks in the gastroyejunal anastomosis (GJA) or in an SG using computed tomography is 60 to 80%.
The upper gastrointestinal catheter (UGS) can also be used to detect leaks but is less sensitive to a leak in GJA than on a CT scan; neither study will effectively rule out the existence of a leak in jejuno-jejunal anastomosis (JJA) after angiography. Persistent tachycardia despite negative results from radiological studies warrants a surgical examination if no other cause can be identified due to low sensitivity of diagnostic tests. In hemodynamically normal patients, control of a leak can also be done through image-guided drainage. However, there are significant differences between SG leak and RYGB leak depending on typical endoluminal pressure; after RYGB gastric bag is low-pressure system and therefore incidence of leaks ranges from 0.6% to 4.4% of patients.9 Because this surgical or non-surgical management strategies that control leak but do not close or repair perforation are effective in 72% patients 10 Patients who have leaks that last more than 30 days can be treated with endoluminal procedure to place clips stents or vacuum bandage to help close these chronic leaks 11 Nutrition can be tackled with distal enteral feeding GJA and is preferable to total parenteral nutrition A feeding tube may be placed Roux limb biliopancreatic limb or common canal Postoperative bleeding requiring intervention occurs up to 11% cases both RYGB SG 23 Fortunately 85% patients are likely stop doing so without surgery 24 Patients with dysmetabolic syndrome X have higher risk bleeding Routine supportive treatment should be instituted promptly and includes establishment adequate venous access crystalloid resuscitation transfusions blood products serial hematocrit hemodynamic monitoring correction any coagulopathy interruption VTE chemoprophylaxis if used An experienced endoscopist can safely evaluate anastomosis in...
