Complications of Morbid Obesity Surgery
The number of weight loss procedures being performed annually continues to increase. It is important for any acute care surgeon to be familiar with commonly performed bariatric procedures and their associated complications. This chapter reviews common com
- PDF / 625,547 Bytes
- 10 Pages / 595.28 x 790.87 pts Page_size
- 103 Downloads / 189 Views
36
Christian Perez, Peter A. Walker, and Shinil K. Shah
The number of weight loss procedures being performed annually continues to increase. Therefore, it is important for the acute care surgeon to be familiar with the complications of common bariatric procedures including adjustable gastric banding, sleeve gastrectomy, and roux-en-y gastric bypass. The following chapter summarizes the complications of different bariatric surgical procedures and highlights the initial evaluation and management [1].
Laparoscopic Adjustable Gastric Band Since its introduction in 1993, the laparoscopic adjustable gastric band (LAGB) gained popularity because of its reversibility, relatively minimal alteration of gastric anatomy, ability to be performed with laparoscopy, and short learning curve. Its popularity has declined in recent years, from 42.3 % of all weight loss surgery procedures in 2008 to 17.8 % in 2011. This is in part secondary to multiple factors including a 40–50 % reoperation rate secondary to device complications, weight loss failure, and significant readmission rates (reported to be over 10 %) [1, 2].
C. Perez • P.A. Walker (*) Department of Surgery, University of Texas Medical School at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX 77030, USA e-mail: [email protected]; [email protected] S.K. Shah Department of Surgery, University of Texas Medical School at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX 77030, USA Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, 6431 Fannin Street, MSB 4.156, Houston, TX 77030, USA e-mail: [email protected]
Intraoperative Complications Refinements in operative techniques, such as dissection through the pars flaccida and routine gastro-gastric plication, have decreased the incidence of previously common complications such as immediate posterior band slippage. Additional intraoperative complications that have been described are gastric and esophageal perforation and splenic injury with associated bleeding. Overall the procedure is extremely safe with a 50 have shown in multiple series to have higher leak rates. The stomach after sleeve gastrectomy is considered to be a high-pressure system. Leaks have been associated with distal strictures that perpetuate the leak secondary to poor distal drainage of the gastric contents [9]. High index of suspicious is required. Tachycardia, fevers, abdominal pain, and persistent hiccups after the procedure should trigger further workup to rule out this feared complication. Some centers use routine postoperative upper gastrointestinal contrast studies before starting a diet on patients but this has not been shown to have any benefits in preventing leaks. Intraoperative endoscopy has also been used to visualize the shape of the sleeve and perform an air leak test. Routine drain placement with measurement of drain amylase levels (levels around 1000 will indicate saliva) has been used by other groups. Most do not routinely place drains after sleeve gas
Data Loading...
