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Common weight loss procedures and their complications

Published:November 30, 2017DOI:https://doi.org/10.1016/j.ajem.2017.11.050

      Abstract

      Background

      As the number of obese patients in the United States continues to grow, there is a parallel increase in the number of bariatric surgery patients. A quarter of these patients will return to the Emergency Department (ED) within the first two years of the index procedure.

      Objective

      An understanding of the most common bariatric procedures and their related complications will greatly aide the Emergency Medicine physician in the care of these patients.

      Discussion

      Abdominal pain is the most common reason for bariatric patients to present to the ED and can represent a diagnostic challenge to EM physicians. It is important that EM physicians have a good understanding of bariatric procedures. We describe the three most common bariatric procedures: 1) the Laparoscopic Adjustable Gastric Banding (LAGB); 2) the Laparoscopic Sleeve Gastrectomy (LSG); 3) and the Roux-en-Y Gastric Bypass (RYGB). Due to the unique altered anatomy following the procedures there are specific complications related to each individual procedure. We will describe the most common presentations of abdominal pain in the post bariatric surgery patient. Finally, we will review new endoscopic procedures and the associated complications that may cause patients to present to the ED.

      Conclusion

      Certain complications in bariatric surgery patients can have a high rate of morbidity and mortality. An improved understanding of bariatric procedures and their complications will allow for improved vigilance and management.

      Keywords

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      References

        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • Flegal K.M.
        Prevalence of childhood and adult obesity in the United States, 2011-2012.
        JAMA. 2014; 31: 806-814
        • Buchwald H.
        • Avidor Y.
        • Brauwald E.
        • et al.
        Bariatric surgery: a systematic review and meta-analysis.
        JAMA. 2004; 292: 1724-1737
        • Angrisani L.
        • Santonicola A.
        • Iovino P.
        • Formisano G.
        • Buchwald H.
        • Scopinaro N.
        Bariatric surgery worldwide 2013.
        Obes Surg. 2015; 25: 1822-1832
        • Pines J.M.
        • Mutter R.L.
        • Zocchi M.S.
        Variation in emergency department admission rates across the United States.
        Med Care Res Rev. 2013; 70: 218-231
        • Telem D.A.
        • Talamini M.
        • Gesten F.
        • Patterson W.
        • Peoples B.
        • Gracia G.
        • et al.
        Hospital admissions greater than 30 days following bariatric surgery: patient and procedure matter.
        Surg Endosc. 2015; 29: 1310-1315
        • Patel S.
        • Eckstein J.
        • Acholonu E.
        • Abu-Jiash W.
        • Szomstein S.
        • Rosenthal R.J.
        Reasons and outcomes of laparoscopic revisional surgery after laparoscopic adjustable banding for morbid obesity.
        Surg Obes Relat Dis. 2010; 6: 391-398
        • Franco J.V.
        • Ruiz P.A.
        • Palermo M.
        • Gagner M.A.
        Review of studies comparing three laparoscopic procedures in bariatric surgery: sleeve gastrectomy, roux-en-y gastric bypass and adjustable gastric banding.
        Obes Surg. 2011; 21: 1458-1468
        • Altieri M.S.
        • Yang J.
        • Telem D.A.
        • et al.
        Lap band outcomes from 19,221 patients across centers and over a decade within the state of New York.
        Surg Endosc. 2016; 30: 1725-1732
        • O'Rourke R.W.
        • Andrus J.
        • Diggs B.S.
        • Scholz M.
        • McConnell D.B.
        • Deveney C.W.
        Perioperative morbidity associated with bariatric surgery: an academic center experience.
        Arch Surg. 2006; 141: 262-268
        • Kellogg T.A.
        • Swan T.
        • Leslie D.A.
        • Buchwald H.
        • Ikramuddin S.
        Patterns of readmission and reoperation within 90 days after roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2009; 5: 416-423
        • Gonzalez-Sánchez J.A1.
        • Corujo-Vazquez O.
        • Sahai-Hernández M.
        Bariatric surgery patients: reasons to visit emergency department after surgery.
        Bol Asoc Med P R. 2007; 99: 279-283
        • Macht R.
        • George J.
        • Ameli O.
        • et al.
        Factors associated with bariatric postoperative emergency department visits.
        Surg Obes Relat Dis. 2016; 12: 1826-1831
        • Belachew M.
        • Belva P.H.
        • Desaive C.
        Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity.
        Obes Surg. 2002; 12: 564-568
        • Sutre M.
        Laparoscopic band repositioning for pouch dilatation/slippage after gastric banding: disappointing results.
        Obes Surg. 2001; 11: 507-512
        • Weiner R.
        • Bockhorn H.
        • Rosenthal R.
        • Wagner D.
        A prospective randomized trial of different laparoscopic gastric banding techniques for morbid obesity.
        Surg Endosc. 2001; 15: 63-68
        • Abu-Abeid S.
        • Szold A.
        Laparoscopic management of lap-band erosion.
        Obes Surg. 2001; 11: 87-89
        • D'Hondt M.
        • Vanneste S.
        • Pottel H.
        • Devriendt D.
        • Van Rooy F.
        • Vansteenkiste F.
        Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss.
        Surg Endosc. 2011; 25: 2498-2504
        • Himpens J.
        • Dobbeleir J.
        • Peeters G.
        Long-term results of laparoscopic sleeve gastrectomy for obesity.
        Ann Surg. 2010; 252: 319-324
        • Hutter M.M.
        • Schirmer B.D.
        • Jones D.B.
        • Ko C.Y.
        • Cohen M.E.
        • Merkow R.P.
        • et al.
        First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass.
        Ann Surg. 2011; 254: 410-420
        • Willson T.D.
        • Gomberawalla A.
        • Mahoney K.
        • Lutfi R.E.
        Factors influencing 30-day emergency visits and readmissions after sleeve gastrectomy: results from a community bariatric center.
        Obes Surg. 2015; 25: 975-981
        • Fuks D.
        • Verhaeghe P.
        • Brehant O.
        • Sabbagh C.
        • Dumont F.
        • Riboulot M.
        • Delcenserie R.
        • Regimbeau JM.
        Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity.
        Surgery. 2009; 145: 106-113
        • Foletto M.
        • Prevedello L.
        • Bernante P.
        • et al.
        Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty.
        Surg Obes Relat Dis. 2010; 6: 146-151
        • Iannelli A.
        • Schneck A.S.
        • Ragot E.
        • Liagre A.
        • Anduze Y.
        • Msika S.
        • et al.
        Laparoscopic sleeve gastrectomy as revisional procedure for failed gastric banding and vertical banded gastroplasty.
        Obes Surg. 2009; 19: 1216-1220
        • Csendes A.
        • Braghetto I.
        • León P.
        • Burgos A.M.
        Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity.
        J Gastrointest Surg. 2010; 14: 1343-1348
        • Dakwar A.
        • Asslia A.
        • Khamaysi I.
        • Kluger Y.
        • Mahajna A.
        Late complication of laparoscopic sleeve gastrectomy.
        Case Rep Gastrointest Med. 2013; 2013: 136153
        • Sakran N.
        • Goitein D.
        • Raziel A.
        • et al.
        Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients.
        Surg Endosc. 2013; 27: 240-245
        • Jurowich C.
        • Thalheimer A.
        • Seyfried F.
        • et al.
        Gastric leakage after sleeve gastrectomy-clinical presentation and therapeutic options.
        Langenbecks Arch Surg. 2011; 396: 981-987
        • Cottam D.
        • Qureshi F.G.
        • Mattar S.G.
        • et al.
        Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity.
        Surg Endosc. 2006; 20: 859-863
        • Ballesta C.
        • Beridoague R.
        • Cabrera M.
        • Palau M.
        • Gonzales M.
        Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass.
        Obes Surg. 2008; 18: 623-630
        • Jacobsen H.J.
        • Nergard B.J.
        • Leifsson B.G.
        • et al.
        Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass.
        Br J Surg. 2014; 101: 417-423
        • Higa K.D.
        • Ho T.
        • Boone K.B.
        Internal hernias after laparoscopic roux-en-Y gastric bypass: incidence, treatment and prevention.
        Obes Surg. 2003; 13: 350-354
        • Carmody B.
        • Demaria E.J.
        • Jamal M.
        • et al.
        Internal hernia after laparoscopic Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2005; 1: 543-548
        • Steele K.E.
        • Prokopowicz G.P.
        • Magnuson T.
        • et al.
        Laparoscopic antecolic Roux-en-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocololic approach.
        Surg Endosc. 2008; 22: 2056-2061
        • Higa K.
        • Ho T.
        • Tercero F.
        • Yunus T.
        • Boone K.B.
        Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up.
        Surg Obes Relat Dis. 2011; 7: 516-525
        • Newsom B.D.
        • Kukora J.S.
        Congenital and acquired internal hernias: unusual causes of small bowel obstruction.
        Am J Surg. 1986; 152: 279-284
        • Martin L.C.
        • Merkle E.M.
        • Thompson W.M.
        Review of internal hernias: radiographic and clinical findings.
        AJR. 2006; 186: 703-717
        • Altieri M.S.
        • Pryor A.D.
        • Telem D.A.
        • Hall K.
        • Brathwaite C.
        • Zawin M.
        Algorithmic approach to utilization of CT scans for detection of internal hernia in the gastric bypass patient.
        Surg Obes Relat Dis. 2015; 11: 1207-1211
        • Jordan J.H.
        • Hocking M.P.
        • Rout W.R.
        Marginal ulcer following gastric bypass for morbid obesity.
        Am Surg. 1991; 57: 286-288
        • Csendes A.
        • Burgos A.M.
        • Altuve J.
        • Bonacic S.
        Incidence of marginal ulcer 1 month and 1 to 2 years after gastric bypass: a prospective consecutive endoscopic evaluation of 442 patients with morbid obesity.
        Obes Surg. 2009; 19: 135-138
        • Zinner M.J.
        • Ashley S.W.
        Maingot's Abdominal Operations.
        11th ed. 472. Appleton & Lange, New York2007
        • MacLean L.D.
        • Rhode B.M.
        • Nohr C.
        • Katz S.
        • McLean A.P.
        Stomal ulcer after gastric bypass.
        J Am Coll Surg. 1997; 185: 1-7
        • Capella J.F.
        • Capella R.F.
        Gastro-gastric fistulas and marginal ulcers in gastric bypass procedures for weight reduction.
        Obes Surg. 1999; 9: 22-27
        • Kannan R.Y.
        • Nutt M.R.
        Are intra-gastric adjustable balloon system safe? A case series.
        Int J Surg Case Rep. 2013; 4: 936-938
        • Sullivan Shelby
        • Stein R.
        • Jonnalagadda Sreenivasa
        • Mullady Daniel
        • Edmundowicz Steven
        Aspiration therapy leads to weight loss in obese subjects: a pilot study.
        Gastroenterology. 2013; 145: 1245-1252