Complications of Bariatric Surgery

Posted by e-Medical PPT Monday, April 16, 2012
Early complications (1-6wks)
Acute Stomal Stenosis (LAGB): ~ 6%
    - Etlg: Perigastric fat, tissue edema.
    - PW: NV+, food intolerance.
    - Dx: UGIS.
    - Tx: conservative…if persist->revision/removal.
    - Prevention: perigastric fat removal.

Pulmonary Embolus: 0-3.3%
Accounts for 30% of mortality.
Prevent: pneumatic compression devices & subq heparin.
Dx: difficult.
Tx when high level of clinical suspicion.

 Bleeding: 0.6-4%
Early Bleeding:
Etlg: d/t staple lines / surgical anastamosis
Mainly intraluminal
PW:Melena, HR↑, HGB↓
Self limited
Tx: PC, reverse anticoagulation, EGD, Surgery.

Leaks: 2-3%
Account for 50% of mortality.
PW:  fever, HR↑, resp. fail.
Dx: UGIS, CT.
Tx: A. Urgent Exploratory surgery:
1. Irrigation.
2. Repair of the defect.
3. Wide ext. drainage.

Gastric remnant distention: rare
Potentially lethal (distention->rupture->peritonitis)
Etlg: Blind pouch distention d/t ileus or mech. obstruction.
PW: pain, hiccups, LUQ tympany, shoulder pain, abdominal distension, tachycardia, or SOB.
X-Ray:  large gastric air bubble.
Tx: decompression with gastrostomy (OR/Percutaneous)

Late complications(7wks-12mo)
Band Erosion: 0-3%
Etlg: gast wall ischemia (tight band, band buckle trauma).
PW: loss of restriction, fever, NV, +Port site infection (B.K).
Dx: EGD.
Tx: removal.

 Band slippage/prolapse: 2-14%
PW: gastric obst (food intol, epig pain, NV).
Dx: UGIS (band malposition, dilated/prolapsed gast. pouch)
Tx: surgical reposition/removal.

   Port/tube Malfunction: 0.4-7%
Etlg: disconnection, port flips, leakage.
PW: weight regain.
Tx: surg repair/exchange hardware.

 Pouch/esophageal dilation (pseudoachalasia synd): 10%
Etlg: tight band, food intake↑, binge eating.
Tx: band deflation, band relocation/removal.

 Esophagitis: rare
Tx: deflation, acid supp., removal..

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