Friday, April 12, 2024

Late Complications Of Bariatric Surgery

How To Manage Staple Line Leakage

Complications from Bariatric Surgery

The treatment option depends on the size of the leakage. Small leaks can be treated with an endoscope where they can be closed easily.

Whereas large leakage will require surgical closure with buttressing suture line. Intra abdominal collection will require drainage either through an image-guided approach or through a surgical approach.

If surgery is undertaken then the collection is drained and the cavity is washed. Postoperatively a drain is placed to drain any collection that is left and to wash the wound.

Wegovy vs Sleeve Gastrectomy: Weight Loss Medicine Vs Surgery

Risks Of Anastomotic Leaking

A leaking anastomosis may cause bleeding and infection until it is treated. These leaks are serious and can be life-threatening. Long-term complications may include ulcers, scarring, and narrowing of the anastomosis , known as a stricture. A drainage tract through the skin called a fistula may also develop. A fistula could develop between the gastric pouch and the bypassed stomach. Pneumonia is another dangerous complication, because digestive juices can spill into the lungs.

If you are considering gastric bypass surgery for obesity, discuss the procedure carefully with your healthcare provider. The overall risk of serious complications should be weighed against the risk of continued obesity. Remember that gastric bypass surgery works best when combined with long-term, healthy lifestyle choices. These involve good nutritional eating habits and regular exercise.

Failure To Lose Weight

The stomach pouch can only hold half a cup of food in the first days after surgery. Over time, the pouch stretches. If you eat larger meals, weight loss may stop. This can happen if the stomach pouch is too large or you don’t follow post-surgery instructions.

Research indicates that around 20% to 35% of individuals experience a long-term failure rate. Failure rate is defined as a body mass index of greater than 35 within 18 to 24 months post-surgery.

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How To Manage Stricture Formation

In this case, management varies according to the cause. If it is because of edema of the surrounding tissues, then the restriction of fluids in the post-operative period and the use of diuretics will correct the problem.

But if it is because the anastomosis lumen is narrow then it will require endoscopic dilation. In some cases, if the endoscopic approach fails then surgery is done and reconstruction of anastomosis is performed.

Complications Of Intragastric Balloon System:

Treatment of chronic obstruction as late complication of adjustable ...

The placement of the intragastric balloon is done through an endoscope. The latest technique allows the patients to swallow the balloon and is the least technical of all the procedures.

Common complications of the intragastric balloon placement are nausea, vomiting, GERD, gastric ulcer, and balloon migration.

Gastric ulcer and balloon migration can be serious and may require surgical correction.

The frequency of each of the complications associated with intragastric balloon placement is tabulated here:

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Talk To Bass Bariatric Surgery Center Today

If youâre experiencing any of these symptoms post-op, please contact your healthcare provider today. Here at BASS Bariatric, weâre devoted to the long game with our patients. Not only do we work with you before your surgery, but weâre also here after, too. Our team of dedicated experts will ensure an easeful experience before, during, and after youâve made this journey. If youâre ready to take the jump and change your life forever, contact our team today.

About The Author

Daniel Roman is a Digital Content Writer at BASS Medical Group. He received his Masters in Journalism from UC Berkeley in 2021. Daniel has published multiple newspaper articles covering public health issues. His latest was a magazine cover story on pandemics and diseases that he co-wrote with Dr. Elena Conis, a historian of medicine, public health, and the environment.

Stenosis Twists Or Kinks

The loss of luminal caliber from stenosis causes patients to report the sensation of stuck food and the urge to regurgitate. These symptoms are like esophageal dysphagia, with inability to pass food or liquid beyond the GJA or sleeve, and can result in protein calorie malnutrition and nutrient deficiencies. Clinicians must address this when caring for patients with a stenosis, regardless of the cause. Thiamine deficiency can present with new-onset neurologic symptoms. All postsurgical bariatric patients presenting acutely with per os intolerance should have a neurologic examination, biochemical testing for malnutrition, and nutrition replacement started empirically via an intravenous route because a new neurologic defect can become permanent if not addressed quickly.

Stenosis after an SG differs from RYGB stenosis in frequency, diagnosis, and therapy. After an SG, true stenosis or stricture occurs infrequently, befalling only 0.69% to 2% of patients. The therapy for a focal stenosis is the same as RYGB stenosis with serial balloon dilations typically two to three treatments are needed prior to achieving the desired diameter. Rarely, there is an extensive length of stenosis, which would benefit from 6 weeks of stenting. If this fails to maintain the diameter, a myotomy, either endoscopic or laparoscopic, is the next treatment option.

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Bariatric Surgery Side Effects: What You Should Know

For patients who live with serious weight-related health complications, bariatric surgery has proven to be an effective option for weight-loss. Bariatric surgery, which includes gastric bypass surgery and other weight-loss surgeries, is a procedure that involves changing the digestive system in order to help you lose weight.

Bariatric surgeries are weight-loss options for people who have tried diet and exercise but have not been able to sustain results. Experts consider these surgeries to be effective, but it is important for patients to note that they do not come without risk. All bariatric surgeries are major procedures, and no procedure is without risk or potential side effects. If you’re considering bariatric surgery, here is what you need to know about common risks and side effects.

Risks Of Gastric Bypass Surgery: Anastomotic Leaking

What are the later complications to a Gastric Bypass?

If you are severely obese and have had trouble losing weight, your healthcare provider tor may recommend weight loss surgery. Weight loss surgery is also known as bariatric surgery. It is an effective way to lose weight and reduce the risk for weight-related problems. These include heart disease, diabetes, high blood pressure, stroke, sleep apnea, and arthritis.

One type of weight loss surgery is the gastric bypass. As with any surgery, gastric bypass carries some risks. Complications of surgery include infection, blood clots, and internal bleeding. Another risk is an anastomosis. This is a new connection created in your intestines and stomach during the bypass surgery that will not fully heal and will leak. Leaking of digestive juices and partially digested food through an anastomosis is one of the most serious complications after gastric bypass surgery.

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How To Treat Nausea And Vomiting Caused By An Intragastric Balloon

This is intolerable for some patients. It may require early removal of the device if the symptoms are severe and totally intolerable.

Those patients with mild symptoms of nausea and vomiting may be treated with short-term antiemetics, antacids, and proton pump inhibitors like omeprazole, pantoprazole, and lansoprazole.

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Nutritional Deficiency After Gastric Bypass Surgery:

As this is malabsorptive surgery, most patients usually develop a deficiency of micro and macronutrients in the long run.

Continuous replacement of the nutrients and a healthy nutrient-rich diet is usually advised to avoid the deficiency of nutrients.

In one study, 14% of the patients who underwent gastric bypass surgery developed iron deficiency at 2 years and 27% of the patients developed iron deficiency at 3 years of the gastric bypass procedure.

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Gastric Sleeve Pros And Cons

Pros of gastric sleeve surgery include:

  • You will likely lose weight, because you will only be able to eat about half a cup of food at a time.
  • It is a permanent surgery.
  • It can improve the health of individuals who have had trouble losing weight and keeping it off.
  • It may help improve long-term health concerns like diabetes and high blood pressure.
  • Death due to gastric sleeve surgery is rare.

However, there are cons to be aware of. It’s still possible to eat too much after gastric sleeve surgery. If you do, you may not lose much weight. This procedure may not help with long-term health conditions and you may experience complications.

Your surgeon will give you a post-surgical plan. Following the plan can help reduce the risk of complications.

Prevention And Management Of Complications After Bariatric Surgery

Ct Scan After Gastric Sleeve

ABSTRACT: Patients undergoing sleeve gastrectomy and gastric bypass require support from health care professionals so that they can recognize complications and make appropriate postsurgical lifestyle adjustments. After surgery, patients must follow a postoperative dietary progression that begins with liquids for 3 weeks and continues with pureed and then soft solids before concluding at 10 weeks with a transition to very small amounts of regular food. Possible complications after surgery include anastomotic leak, internal hernia, ulcer, dumping syndrome, and gallstone formation. As well as watching for such complications after surgery, patients must make adjustments regarding constipation management, medication use, alcohol consumption, nutritional supplementation, contraception, and lifestyle behaviors. Failure to follow dietary guidelines and a lack of exercise can be reasons for regaining weight or not losing enough weight after surgery. With a change in lifestyle and successful weight loss after surgery, patients can reduce obesity-related comorbidities and increase their overall energy and confidence.

Patients undergoing sleeve gastrectomy or gastric bypass should be prepared to recognize complications such as anastomotic leak and dumping syndrome, and to follow instructions regarding dietary progression, nutritional supplementation, and exercise.

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Difficulties In Adherence To Long

Patients who are lost to follow-up and poor quality surveillance increase the long-term risk of medical, surgical, and/or psychiatric complications.

Long-term multidisciplinary follow-up is recommended because of the risk of regaining weight, nutritional deficiencies, and potentially severe medical and surgical complications . In light of the ever-increasing number of patients undergoing surgery, adequate follow-up is a

How To Manage A Perforated Bulbar Ulcer

In this case, the patient will present with severe abdominal pain with board-like abdominal rigidity because the stomach contents are highly irritative and cause severe peritonitis.

This will require surgery with removal of band and closure of perforation with omentopexy to strengthen the perforation site.

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Gastric Bypass And Malnutrition

Gastric bypass not only limits the kinds of foods you can, eat but also the quantity of food. Additionally, it limits the nutrients that your body is able to absorb. To avoid malnutrition from vitamin deficiency after gastric bypass, you will need to work with a nutritionist to ensure that you are getting the proper nutrients from your diet. This may include subsidizing your diet with vitamin supplements:

Complications Of Gastric Bypass Surgery

Bariatric Surgery Procedure | Duodenal Switch Surgery

The surgical complication is defined as the deviation from ordinary postoperative course whether symptomatic or asymptomatic. This differs from failure or sequela. A surgical sequel is expected aftermath of a surgical procedure, i.e., inability to breastfeed following the removal of both breasts due to malignancy.

Failure, on the other hand, is said to have occurred when the purpose of the surgery is not achieved.1

Gastric bypass surgery is one of the surgical procedures performed for the treatment of morbid obesity . It is also done for those who are not morbidly obese but have failed to lose appreciable weight with non-operative management of obesity and those with obesity-associated conditions.

The commonest of this type of surgery is the laparoscopic Roux-en-Y gastric bypass. This surgery is both a restrictive and malabsorptive surgery.

It involves reduction of the stomachs capacity by compartmentalization into an upper pouch of about 30mls and a lower bigger non-functioning pouch. This is achieved with the use of staples. In a proximal Roux-en-Y gastric bypass, the small intestine is then divided at about 45cm from the lower stomach pouch, and the distal end of the divide is connected to the small upper stomach pouch. While the proximal end of the divide is connected to the small intestine at about 100cm distal to the site of division.2

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    Common Complications Of Bariatric Surgery:

    Gastrointestinal side effects are the most common. Invasive procedures are associated with complications of surgery such as anastomosis leakage and adhesions resulting in intestinal obstruction later in life.

    Lastly, pancreatic exocrine insufficiency and malabsorption are common with some of the procedures.

    Here is a list of the complications of weight loss surgery:

    • Nausea and vomiting
  • Duodenal switch with biliopancreatic diversion
  • Each of the above weight loss procedures is associated with different complications.

    Types Of Bariatric Surgery

    Generally speaking, bariatric surgeries can be divided into 2 main categories:

    • Gastric restriction
    • Concept: creation of a smaller gastric pouch that induces early satiety and decreases food intake
    • Example: Sleeve Gastrectomy
  • Patient factors: Results dependent on patients compliance with dietary restrictions.
    • Procedure: bypassing segments of the small bowel reduces absorption
    • Example: Roux-en-Y gastric bypass.
  • Patient factors: Less dependent on patients dietary compliance compared to restrictive strategies18.
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    Late Complications Of Bariatric Surgery: Signs To Look Out For

    As far as late-stage complications go, these can be trickier to spot. When youâre a few months to a year out of surgery, itâs challenging to identify symptoms caused by your operation. This is why itâs vital to come up with a post-op plan with your team of doctors. Continue to schedule consultations, doctor visits, and work with a team of supportive professionals. This way, you can reduce the risk of complications significantly. If you feel as though something is off, remember to visit your healthcare professional as soon as possible.

    Late-stage complications of bariatric surgery include, but are not limited to:

    • âDumping syndrome: This is extremely common for those whoâve undergone gastric bypass or gastric sleeve. Dumping syndrome occurs when food, particularly sugar, moves too quickly from the stomach to the small intestine. You may experience dizziness, nausea, vomiting, abdominal pain, bloating, or irregular heartbeat as a result.
    • Hernias: A hernia occurs when a gap in the muscular wall allows the abdomen to protrude outward. They form when thereâs a combination of pressure and weak muscle. These can be painful and will worsen over time. Remember to incorporate regular exercise and movement into your post-op recovery plan to avoid hernias from forming.

    Late Complications Of Bariatric Surgical Operations

    A Case of Pneumopericardium as a Late Complication of Gastric Bypass ...
    Wenliang Chen, MD, PhD

    INTRODUCTION The number of bariatric surgical operations performed in the United States has been steadily increasing for the last five years. It is estimated that 256,000 weight-loss surgeries were performed in 2019 . Of those, 60 percent were sleeve gastrectomy, 18 percent were gastric bypass, 1 percent were gastric band, and 1 percent were biliopancreatic diversion with duodenal switch. The remaining 20 percent were revisional procedures.

    Complications following surgical treatment of severe obesity vary based upon the procedure performed and can be as high as 40 percent . Due to the high surgical volume, improving the safety of these operations has become a high priority, leading to the development of strict criteria for center accreditation, guidelines for safe and effective bariatric surgery, and careful monitoring of surgical outcomes .

    This topic will review the major late complications of bariatric surgery, defined as occurring after 30 days. A description of bariatric procedures, indications and preoperative management, short-term medical outcomes, and long-term complications of laparoscopic operations are reviewed as separate topics.

    Clinical features include pain, hiccups, left upper quadrant tympany, shoulder pain, abdominal distension, tachycardia, or shortness of breath. Radiographic assessment may demonstrate a large gastric air bubble.

    Causes of marginal ulcers include :

    Nonsteroidal anti-inflammatory drug use



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    Early Complications Are Almost Similar In All Bariatric Operations And Are Listed As Under:

  • Anaesthesia related complications
  • Venous thrombo-embolism – Patients suffering from severe obesity are prone to developing a blood clot in their leg veins. At times this can travel up to their heart or lungs. This is one of the most catastrophic complications and can be fatal. We take all precautions in terms of blood thinner medications, compression stockings and pumps and early mobilization to prevent this.
  • Intra-operative injuries to other organs Rarely, other organs like liver, spleen, intestine mesenteric fat or blood vessels may get injured during surgery. If detected early, these can be tackled effectively.
  • Haemorrhage or bleeding This can occur due to injury to a blood vessel or sometimes bleeding may also happen from staple line or the anastomotic sites.
  • Leaks Leaks can happen from any staple lines or any of the anastomosis. This leads to leakage of the enteral contents into the abdominal cavity. This can lead to localized infection or sometimes widespread septicaemia.
  • Wound infection The rates of wound infections have come down drastically since the advent of laparoscopy. However, sometimes the wound may still get infected
  • Bariatric Surgery Complications In The Urgent Care Center

    Urgent message: Obesity continues to be a significant health problem in the United States, with more and more patients opting for a surgical solution to their own weight loss challenges. As this trend continues, urgent care providers can expect to see more patients with post bariatric surgery complaints, ranging from the typical and benign to pulmonary emboli, anastomotic leaks, and respiratory failure account.

    Tracey Quail Davidoff, MD, FCUCM

    Obesity has become one of the foremost public health concerns in our time. It may result in poor self-esteem, depression, discrimination, as well as diabetes , coronary artery disease , and obstructive sleep apnea . Because dieting in the morbidly obese is often futile or produces results that are short-lived, both providers and patients are looking for effective long-term solutions to this problem.

    Bariatric surgery leads to sustainable long-term weight loss and may be curative for obesity-related conditions including DM and OSA.1 As the number of patients undergoing these procedures increases, the urgent care provider needs to be aware of early and late complications. Recognizing the serious complications, knowing how to treat, and what to refer are key in providing appropriate urgent care to these patients.


    Bariatric surgery may offer a long-term solution to those with morbid obesity. However, the postsurgery period is a lifelong commitment with permanent health and lifestyle changes that require strict compliance.3

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