Diego Camacho (editor) - Complications in Bariatric Surgery
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This text focuses on the complications following bariatric surgery. The focus is on the immediate and long term complications that would be important to both the general surgeon and those surgeons with specialty experience in bariatric surgery. Sections address the nutritional deficiencies following bariatric surgery with specific attention to Roux en Y gastric bypass and pancreatico-biliary diversion as well as the correction of these deficiencies with medical intervention as well as the indications for surgical revision or reversal. The text reviews the work-up of a bariatric patient with abdominal pain including the appropriate imaging and threshold for operative intervention and the techniques to achieve optimal visualization during this difficult situation. This section focuses on the operative management of anastomotic and staple line leaks and how to definitively manage these surgical emergencies as well as achieve source control and stabilization. Later chapters focus on specific complications following bariatric surgery with specific focus on RYGB, vertical sleeve gastrectomy (VSG), biliary pancreatic diversion, and gastric band. Complications include gastric fistula, gastric staple line disruption following VSG, gastro-jejunal leak following RYGB, relux following bariatric surgery, and failure of weight loss following bariatric surgery. These sections are written by experts in the field of bariatrics and include evidence based medicine as well as expert opinion on the management of bariatric complications. The sections provide a review of the literature and references at the close of each section.
Complications in Bariatric Surgery will serve as a resource for both the general surgeon who handles bariatric emergencies as well as the bariatric specialist.
Complications in Bariatric Surgery will serve as a resource for both the general surgeon who handles bariatric emergencies as well as the bariatric specialist.
Diego Camacho (editor): author's other books
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Diego Camacho (editor)
Thomas B. McNemar
Paula Kennard
Michelle Bontempo-Saray
David Haslam (editor)
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Springer International Publishing AG, part of Springer Nature 2018
Diego Camacho and Natan Zundel (eds.) Complications in Bariatric Surgery1. Introduction
Diego Camacho 1
(1)
Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
(2)
Department of General Surgery, NYC Health + Hospitals/Jacobi, Bronx, NY, USA
Diego Camacho (Corresponding author)
Email:
Dina Podolsky
Email:
Keywords
Bariatric surgery Obesity Weight loss Morbidity Complications ManagementIntroduction
Over the past 60 years, the field of bariatric surgery has experienced an unprecedented growth in popularity as it has proven to be the most effective treatment of obesity and its associated comorbidities. It is estimated that nearly 200,000 bariatric procedures are performed annually in this country, a volume that may be satisfying less than 1% of the populations need []. As weight loss surgery is being offered to increasingly complex patients with ever-rising BMIs, the impetus remains on the surgical community to provide this service in a safe and responsible manner. This textbook aims to define frequently encountered postoperative complications following weight loss surgery (WLS) , as well as the current standards of care for treating them.
Over the past several decades, multiple factors have come together to decrease morbidity and mortality following WLS. From a technical standpoint, the widespread adoption of laparoscopy has greatly increased the safety profile of WLS; currently, over 90% of all bariatric surgery procedures are completed using minimally invasive techniques [].
According to the most recent ASBMS data , sleeve gastrectomy is the most frequently performed bariatric procedure (54%), followed by gastric bypass (23%), revisional surgery (14%), and gastric banding (6%) []. Maintaining a high degree of suspicion in the postoperative period is imperative, as the majority of these complications can be managed effectively when diagnosed early. In less stable patients, frequently surgical re-exploration is required, a fact that any surgeon engaging in WLS should be prepared for.
Late postoperative complications , or those occurring after 30 days following the index procedure, include anastomotic stenosis, gallstone formation, bowel obstruction, intussusception, marginal ulcers, and fistula formation []. The use of advanced imaging techniques such as CT scan combined with a high index of suspicion can help turn these once deadly events into manageable complications. In many instances, surgical re-exploration remains the standard of care.
The purpose of this textbook is to provide a comprehensive and up-to-date reference for the management of complications stemming from bariatric surgery procedures, written by and for bariatric surgeons. Each chapter delves into common problems associated with the most frequently performed bariatric procedures, spanning the spectrum from acute to chronic presentations with a focus on both diagnosis and treatment. Our hope is that the words written in this book will provide guidance to those taking care of patients in need, as well as the tools necessary for the next generation of bariatric surgeons to continue this great public service in a safe and effective manner.
References
Ibrahim AM, Ghaferi AA, Thumma JR, Dimick JB. Variation in outcomes at bariatric surgery centers of excellence. JAMA Surg. Published online April 26, 2017. https://doi.org/10.1001/jamasurg.2017.0542 .
ONeill KN, Finucane FM, le Roux CW, Fitzgerald AP, Kearney PM. Unmet need for bariatric surgery. Surg Obes Relat Dis. 2016 pii: S1550-7289(16)30879-6. https://doi.org/10.1016/j.soard.2016.12.015 .
American Society for Metabolic and Bariatric Surgery. Metabolic and bariatric surgery. http://asmbs.org/resources/metabolic-and-bariatric-surgery . Accessed 31 May 2016.
Lim RB. Complications of gastric bypass and repair. In: Fischer JE, editor. Fischers mastery of surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.
American Society for Metabolic and Bariatric Surgery. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). https://asmbs.org/about/mbsaqip . Accessed May 31, 2016.
Gebhart A, Young M, Phelan M, Nguyen NT. Impact of accreditation in bariatric surgery. Surg Obes Relat Dis. 2014;10(5):76773. Crossref
Telem DA, et al. Rates and risk factors for unplanned emergency department utilization and hospital readmission following bariatric surgery. Ann Surg. 2016;263(5):95660. Crossref
American Society for Metabolic and Bariatric Surgery. Estimate of bariatric surgery numbers. 20112015. http://asmbs.org/resources/estimate-of-bariatric-surgery-numbers . Accessed 31 May 2016.
DeMaria, et al. Baseline data from the American Society for Metabolic and Bariatric Surgery designated bariatric surgery centers of excellence using bariatric outcomes longitudinal database. Surg Obese Relat Dis. 2010;6(4):34755. Crossref
Coblijn UK, et al. Predicting postoperative complications after bariatric surgery: the Bariatric Surgery Index for Complications, BASIC Surg Endosc 2017. https://doi.org/10.1007/s00464-017-5494-0 . [Epub ahead of print].
Aghajani E, Nergaard BJ, Leifson BG, et al. The mesenteric defects in laparoscopic roux-en-Y gastric bypass: 5 years follow-up of non-closure versus closure using the stapler technique. Surg Endosc. 2017. Published online February 15, 2017. https://doi.org/10.1007/s00464-017-5415-2 .
Springer International Publishing AG, part of Springer Nature 2018
Diego Camacho and Natan Zundel (eds.) Complications in Bariatric Surgery2. Metabolic Complications, Nutritional Deficiencies, and Medication Management Following Metabolic Surgery
Christopher D. Still 1
(1)
Department of Nutrition and Weight Management & Geisinger Obesity Institute, Geisinger Health Care System, Danville, PA, USA
(2)
Geisinger Medical Center, Geisinger Obesity Institute, Danville, PA, USA
(3)
Department of Nutrition and Weight Management, Geisinger Health Care System, Danville, PA, USA
Christopher D. Still (Corresponding author)
Email:
Peter Benotti
Daniela Hangan
Email:
Fahad Zubair
Email:
Keywords
Metabolic bone disease Nephrolithiasis Hypoglycemia Nutrient deficiency Neurological complicationsIntroduction
Surgical procedures for weight management have been a part of the standard of care for patients with severe obesity since 1991. The rise in the prevalence of severe obesity and significant improvements in surgical quality and outcomes have enhanced patient and physician awareness of the health-protective and health-restorative benefits of surgical treatment for obesity and a rapid increase in the number of surgical weight loss procedures performed. The emergence of multidisciplinary care for patients with severe obesity in collaboration with metabolic surgeons has led to improved perioperative patient management and has contributed to the discovery of metabolic and nutritional complications which will be discussed in detail in this chapter.
Current Operative Procedures
The laparoscopic Roux-en-Y gastric bypass (Fig. ) involves the creation of a small (1520 ml) gastric reservoir, which is separated from the remaining stomach. The gastric reservoir is connected by a small, calibrated anastomosis to a Roux-en-Y limb of jejunum, thus bypassing the duodenum and proximal jejunum. Until this past year, this has been the most popular procedure performed in the USA.
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