Bariatric Surgery Complications - Revision history

Rossdonaldson1: Redirected page to Bariatric surgery complications

2015-09-11T01:39:00Z

Redirected page to Bariatric surgery complications

← Older revision		Revision as of 01:39, 11 September 2015
Line 1:		Line 1:
	~~==Roux-en-Y gastric bypass==~~		#REDIRECT[[Bariatric surgery complications]]
	*Creation of a small gastric pouch and an anastomosis to the jejunum
	*'''Gastric remnant distension'''<ref>Lee S, Carmody B, Wolfe L, Demaria E, Kellum JM, Sugerman H, Maher JW. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3828 gastric bypass cases. J Gastrointest Surg. 2007;11(6):708. </ref>
	**Remnant is a blind pouch that may become distended with paralytic ileus
	**Potential rupture → severe peritonitis
	**3.9% leak rate for RYGB; overall mortality 0.6%
	**Jejunojejunostomy leak a/w 40% mortality
	**S/s: pain, hiccups, LUQ tympany, shoulder pain, abd distention
	**Dx: XR shows large gastric air bubble vs CT
	**Tx: emergent operative decompression with percutaneous drainage
	*'''Stomal Stenosis'''
	**Occurs in 6-20% of RYGB pts
	**Possibly related to tissue ischemia or tension on GJ anastomosis
	**Presentation several weeks after surgery
	**S/s: N/V, dysphagia, GERD, inability to tolerate PO
	**Dx with endoscopy vs UGI series vs CT
	*'''Marginal Ulcers'''
	**Occur in 0.6-16% of RYGB pts
	**Acid injury to jejunum
	**Causes: poor perfusion 2/2 tension/ischemia, increase gastric acid exposure, NSAID use, H pylori infection
	**S/s: Nausea, pain, bleeding +/- perforation
	**Dx with endoscopy
	**Patients typically medically managed
	*'''Cholelithiasis'''
	**38% of RYGB pts
	***Risk reduced to 2% if ursodiol given as post-op ppx
	***Some surgeons perform prophylactic cholecystectomy with RYB procedure
	**Rapid weight loss increases lithogenicity of bile
	**Dx: U/S or MRCP
	*'''Hernias'''
	**Ventral hernias (0-1.8% in lap RYGB)
	**Internal hernias (0-5%)
	***Intermittent and may be difficult to detect via CT
	***Suspected may require urgent surgical exploration lest patient has strangulated pathology
	*'''Dumping Syndrome'''
	**Occur in up to 50% of pts when high levels of carbohydrates are ingested
	**Early dumping syndrome
	***Hyperosmolality of food → fluid shifts → colicky and pain, diarrhea, nausea, tachycardia
	***Tx: Diet modification to avoid high simple sugars
	**Late dumping syndrome
	***Insulin response that leads to hypoglycemia 2-3 hours after meal
	***S/s: dizziness, fatigue, diaphoresis, weakness

	~~==Gastric Banding==~~
	*Placement of restrictive ring over the gastric cardia near the GE junction
	*Lowest mortality rate among all bariatric surgeries (0.05% mortality)
	*'''Stomal Obstruction'''
	**Early complication; occurs in 14% go GB pts
	**Typically 2/2 inclusion over excess perigastric fat vs tissue edema vs inappropriate sized band
	**S/s: N/V, inability to tolerate PO
	**Dx: UGI series vs CT
	**If due to edema, may be treated with NG tube decompression until swelling improves
	***May require surgical revision if above unsuccessful
	*'''Port infection'''
	**0.3-9% of GB patients
	**a/w band erosion
	**Tx: Replacement of port if isolated infection vs band if more extensive
	*'''Band Erosion'''
	**Up to 7% of GB pts
	**Erodes through gastric wall 2/2 wall ischemia vs mechanical stress from band
	**Occurs on average 22 months after surgery
	**S/s: e/o infection, failure to lose weight, N/V; epigastric pain and hematemesis
	**Dx: Endoscopy vs CT
	**Tx: Band removal
	*'''Band Slippage/gastric prolapse'''
	**2-14% of pts
	**Either anterior or posterior prolapse
	**S/s: Food intolerance, epigastric pain, acid reflux
	**Dx: Upper GI series vs CT
	**Tx: Emergent surgery
	*'''Esophageal dilatation'''
	**Up to 10% of pts
	**a/w over-inflated bands or excessive food intake
	**S/s: Food/saliva intolerance, reflux, epigastric pain
	**Dx: UGI series vs CT
	**Tx: Fluid removal from band initially and behavioral modifications
	*'''Hiatus hernia'''
	**Results in refractory reflux

	~~==Sleeve gastrectomy==~~
	*Creates sleeve out of the stomach and removes portion of greater curvature of stomach
	*Complication rate 3-24%; mortality 0.39%
	*'''Bleeding'''
	**Typically occur from the staple line
	*'''Stenosis'''
	**Can lead to gastric outlet obstruction
	**S/s: Dysphagia, vomiting, dehydration, inability to tolerate PO
	**Dx: UGI series vs CT
	**Tx: Endoscopic dilatation vs surgical intervention depending on involvement
	*'''Gastric leaks'''
	**Up to 5.3% of pts; most serious complication a/w sleeve gastrectomy
	**2/2 poor healing in setting of inadequate blood supply vs weakness at staple line vs gastric-wall heat ischemia from cautery
	**Tx: surgical repair vs percutaneous drainge/abx/NPO
	*'''Reflux'''
	**Common post-op complication
	**Treated medically initially with eventual RYGB for refractory cases

	~~==References==~~
	~~<references/>~~
	*UTD

User238345 at 01:25, 11 September 2015

2015-09-11T01:25:32Z

← Older revision		Revision as of 01:25, 11 September 2015
Line 89:		Line 89:
	**Tx: Endoscopic dilatation vs surgical intervention depending on involvement		**Tx: Endoscopic dilatation vs surgical intervention depending on involvement
	*'''Gastric leaks'''		*'''Gastric leaks'''
	**Up to 5.3% of pts; most serious complication a/w GB		**Up to 5.3% of pts; most serious complication a/w sleeve gastrectomy
	**2/2 poor healing in setting of inadequate blood supply vs weakness at staple line vs gastric-wall heat ischemia from cautery		**2/2 poor healing in setting of inadequate blood supply vs weakness at staple line vs gastric-wall heat ischemia from cautery
	**Tx: surgical repair vs percutaneous drainge/abx/NPO		**Tx: surgical repair vs percutaneous drainge/abx/NPO

User238345: Created page with "==Roux-en-Y gastric bypass== Creation of a small gastric pouch and an anastomosis to the jejunum '''Gastric remnant distension'''Lee S, Carmody B, Wolfe L, Demaria E, K..."

2015-09-10T15:05:39Z

Created page with "==Roux-en-Y gastric bypass== *Creation of a small gastric pouch and an anastomosis to the jejunum *'''Gastric remnant distension'''<ref>Lee S, Carmody B, Wolfe L, Demaria E, K..."

New page

==Roux-en-Y gastric bypass==
*Creation of a small gastric pouch and an anastomosis to the jejunum
*'''Gastric remnant distension'''<ref>Lee S, Carmody B, Wolfe L, Demaria E, Kellum JM, Sugerman H, Maher JW. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3828 gastric bypass cases. J Gastrointest Surg. 2007;11(6):708. </ref>
**Remnant is a blind pouch that may become distended with paralytic ileus
**Potential rupture → severe peritonitis
**3.9% leak rate for RYGB; overall mortality 0.6%
**Jejunojejunostomy leak a/w 40% mortality
**S/s: pain, hiccups, LUQ tympany, shoulder pain, abd distention
**Dx: XR shows large gastric air bubble vs CT
**Tx: emergent operative decompression with percutaneous drainage
*'''Stomal Stenosis'''
**Occurs in 6-20% of RYGB pts
**Possibly related to tissue ischemia or tension on GJ anastomosis
**Presentation several weeks after surgery
**S/s: N/V, dysphagia, GERD, inability to tolerate PO
**Dx with endoscopy vs UGI series vs CT
*'''Marginal Ulcers'''
**Occur in 0.6-16% of RYGB pts
**Acid injury to jejunum
**Causes: poor perfusion 2/2 tension/ischemia, increase gastric acid exposure, NSAID use, H pylori infection
**S/s: Nausea, pain, bleeding +/- perforation
**Dx with endoscopy
**Patients typically medically managed
*'''Cholelithiasis'''
**38% of RYGB pts
***Risk reduced to 2% if ursodiol given as post-op ppx
***Some surgeons perform prophylactic cholecystectomy with RYB procedure
**Rapid weight loss increases lithogenicity of bile
**Dx: U/S or MRCP
*'''Hernias'''
**Ventral hernias (0-1.8% in lap RYGB)
**Internal hernias (0-5%)
***Intermittent and may be difficult to detect via CT
***Suspected may require urgent surgical exploration lest patient has strangulated pathology
*'''Dumping Syndrome'''
**Occur in up to 50% of pts when high levels of carbohydrates are ingested
**Early dumping syndrome
***Hyperosmolality of food → fluid shifts → colicky and pain, diarrhea, nausea, tachycardia
***Tx: Diet modification to avoid high simple sugars
**Late dumping syndrome
***Insulin response that leads to hypoglycemia 2-3 hours after meal
***S/s: dizziness, fatigue, diaphoresis, weakness

==Gastric Banding==
*Placement of restrictive ring over the gastric cardia near the GE junction
*Lowest mortality rate among all bariatric surgeries (0.05% mortality)
*'''Stomal Obstruction'''
**Early complication; occurs in 14% go GB pts
**Typically 2/2 inclusion over excess perigastric fat vs tissue edema vs inappropriate sized band
**S/s: N/V, inability to tolerate PO
**Dx: UGI series vs CT
**If due to edema, may be treated with NG tube decompression until swelling improves
***May require surgical revision if above unsuccessful
*'''Port infection'''
**0.3-9% of GB patients
**a/w band erosion
**Tx: Replacement of port if isolated infection vs band if more extensive
*'''Band Erosion'''
**Up to 7% of GB pts
**Erodes through gastric wall 2/2 wall ischemia vs mechanical stress from band
**Occurs on average 22 months after surgery
**S/s: e/o infection, failure to lose weight, N/V; epigastric pain and hematemesis
**Dx: Endoscopy vs CT
**Tx: Band removal
*'''Band Slippage/gastric prolapse'''
**2-14% of pts
**Either anterior or posterior prolapse
**S/s: Food intolerance, epigastric pain, acid reflux
**Dx: Upper GI series vs CT
**Tx: Emergent surgery
*'''Esophageal dilatation'''
**Up to 10% of pts
**a/w over-inflated bands or excessive food intake
**S/s: Food/saliva intolerance, reflux, epigastric pain
**Dx: UGI series vs CT
**Tx: Fluid removal from band initially and behavioral modifications
*'''Hiatus hernia'''
**Results in refractory reflux

==Sleeve gastrectomy==
*Creates sleeve out of the stomach and removes portion of greater curvature of stomach
*Complication rate 3-24%; mortality 0.39%
*'''Bleeding'''
**Typically occur from the staple line
*'''Stenosis'''
**Can lead to gastric outlet obstruction
**S/s: Dysphagia, vomiting, dehydration, inability to tolerate PO
**Dx: UGI series vs CT
**Tx: Endoscopic dilatation vs surgical intervention depending on involvement
*'''Gastric leaks'''
**Up to 5.3% of pts; most serious complication a/w GB
**2/2 poor healing in setting of inadequate blood supply vs weakness at staple line vs gastric-wall heat ischemia from cautery
**Tx: surgical repair vs percutaneous drainge/abx/NPO
*'''Reflux'''
**Common post-op complication
**Treated medically initially with eventual RYGB for refractory cases

==References==
<references/>
*UTD

Bariatric Surgery Complications - Revision history

Rossdonaldson1: Redirected page to Bariatric surgery complications

User238345 at 01:25, 11 September 2015

User238345: Created page with "==Roux-en-Y gastric bypass== *Creation of a small gastric pouch and an anastomosis to the jejunum *'''Gastric remnant distension'''Lee S, Carmody B, Wolfe L, Demaria E, K..."

User238345: Created page with "==Roux-en-Y gastric bypass== Creation of a small gastric pouch and an anastomosis to the jejunum '''Gastric remnant distension'''Lee S, Carmody B, Wolfe L, Demaria E, K..."