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Langenbeck's Archives of Surgery
Erschienen in: Langenbeck's Archives of Surgery 5/2013

01.06.2013 | Review Article

Acute complications after laparoscopic bariatric procedures: update for the general surgeon

verfasst von: Fabio Cesare Campanile, Cristian E. Boru, Mario Rizzello, Alessandro Puzziello, Catalin Copaescu, Giuseppe Cavallaro, Gianfranco Silecchia

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 5/2013

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Abstract

Background

Development and widespread use of laparoscopic bariatric surgery exposes emergency room physicians and general surgeons to face acute or chronic surgical complications of bariatric surgery.

Methods

The most common surgical emergencies after bariatric surgery are examined based on an extensive review of bariatric surgery literature and on the personal experience of the authors' practice in four high-volume bariatric surgery centers.

Results

An orderly stepwise approach to the bariatric patient with an emergency condition is advisable. Resuscitation should follow the same protocol adopted for the non-bariatric patients. Consultation with the bariatric surgeon should be obtained early, and referral to the bariatric center should be considered whenever possible. The identification of the surgical procedure to which the patient was submitted will orient in the diagnosis of the acute condition. Procedure-specific complication should always be taken into consideration in the differential diagnosis. Acute slippage is the most frequent complication that needs emergency treatment in a laparoscopic gastric banding. Sleeve gastrectomy and gastric bypasses may present with life-threatening suture leaks or suture line bleeding. Gastric greater curvature plication (investigational restrictive procedure) can present early complications related to prolonged postoperative vomiting. Both gastric bypass and bilio-pancreatic diversion may cause anastomotic marginal ulcer, bleeding, or rarely perforation and severe stenosis, while small bowel obstruction due to internal hernia represents a surgical emergency, also caused by trocar site hernia, intussusceptions, adhesions, strictures, kinking, or blood clots. Rapid weight loss after bariatric surgery can cause cholecystitis or choledocholithiasis, which are difficult to treat after bypass procedures.

Conclusions

The general surgeon should be informed about modern bariatric procedures, their potential acute complications, and emergency management.
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Metadaten
Titel
Acute complications after laparoscopic bariatric procedures: update for the general surgeon
verfasst von
Fabio Cesare Campanile
Cristian E. Boru
Mario Rizzello
Alessandro Puzziello
Catalin Copaescu
Giuseppe Cavallaro
Gianfranco Silecchia
Publikationsdatum
01.06.2013
Verlag
Springer-Verlag
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 5/2013
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-013-1077-2

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