Original article
Unexplained abdominal pain in morbidly obese patients after bariatric surgery

https://doi.org/10.1016/j.soard.2017.05.027Get rights and content

Abstract

Background

There is an overall complication rate of 6.3%–10% after bariatric surgery. After ruling out anatomic/physical causes, there is a substantial group of patients who develop unexplained postsurgical abdominal pain.

Objectives

To inventory the prevalence of unexplained abdominal pain after laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy and to determine predictive factors for unexplained abdominal pain.

Setting

Obesity Center Amsterdam, Amsterdam, the Netherlands.

Methods

A retrospective study in a prospective database was performed. Baseline characteristics and postoperative course were evaluated.

Results

A total of 1788 patients underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy between November 2007 and April 2015. The average follow-up consisted of 33.5 months, without loss to follow-up. Abdominal pain was presented in 387 patients (21.6%). The study population consisted of 337 women (87.1%) and 50 men (12.9%); the mean age was 43.3 years (standard deviation 10.1) and the median preoperative body mass index was 43.7 kg/m². An explanation for abdominal pain was found in 246 of 387 patients (63.6%), whereas no explanation was found in 133 patients (34.4%). Revisional surgery was a significant predictor for unexplained pain (odds ratio 1.7; confidence interval 1.0–2.8; P = 0.037).

Conclusion

A total of 133 patients (7.4%) experienced unexplained abdominal pain after laparoscopic bariatric surgery. Revisional surgery was found to be a significant predictive factor for this outcome. Present study results suggest that postoperative unexplained abdominal pain is a significant morbidity and should be part of the informed consent. More research is needed regarding further diagnosis and management and treatment.

Section snippets

Study design and population

This is a retrospective study of a database with morbidly obese patients who underwent bariatric surgery between November 2007 and April 2015 in the Obesity Centre Amsterdam. Patients who underwent a primary LRYGB, primary LSG, or revisional surgery from laparoscopic adjustable gastric banding into LRYGB/LSG were included.

Data collection

The data were collected from electronic medical records and were anonymously entered in a database. The Institutional Medical Ethics Committee gave approval for this study,

Results

A total of 1788 patients underwent bariatric surgery between November 2007 and April 2015. Primary LRYBG and LSG were performed in 1361 and 118 patients, respectively, and revisional surgery was performed in 309 patients. The average follow-up consisted of 33.5 months, with a minimum and maximum period of 6 and 95 months, respectively. The postoperative course of all patients with abdominal pain was evaluated; none of the patients were lost to follow-up. Postoperative abdominal pain was present

Discussion

In 2011, an estimated 340,000 bariatric procedures were performed worldwide. Most commonly the LRYGB and the LSG [8]. With the still increasing number of bariatric procedures, knowledge of related complications is important. Unexplained abdominal pain is an increasing phenomenon in our bariatric surgical practice. Therefore, this study was performed to determine the incidence of unexplained abdominal pain and to detect predictive factors. A total of 387 patients (21.6%) experienced

Conclusion

It can be concluded that unexplained abdominal pain is an important postoperative complication that is important to acknowledge with an occurrence of 7.4 % in the bariatric surgery population. Revisional bariatric surgery was a predictive factor for the development of unexplained abdominal pain compared with explained abdominal pain, whereas the variables female sex, preoperative BMI, and type of surgery were statistically different between patients with unexplained abdominal pain and without

Disclosure

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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