Complications of Bariatric Surgery - ESadot

Complications of Bariatric Surgery - ESadot - Complications...

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Complications of Bariatric Surgery Eran Sadot, MD.
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Mortality (30d): - Overall: 0.1%-1% - Restrictive: 0.1% - GBP: 0.5% - BPD+ DS: 1.1% - Higher: Male, Elderly, Surgeon experience↓ • Buchwald, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004. • Maggard, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med 2005.
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Focus : RYGB, LAGB. 3 categories : 1. Early complications (1-6wks). 2. Late complications(7wks-12mo). 3. Very late complications.
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Early complications (1-6wks)
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Acute Stomal Stenosis (LAGB): ~ 6% - Etlg: Perigastric fat, tissue edema. - PW: NV+, food intolerance. - Dx: UGIS. - Tx: conservative…if persist->revision/removal. - Prevention: perigastric fat removal. Early Complications - LAGB
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Pulmonary Embolus : 0-3.3% –Accounts for 30% of mortality. Dx: difficult. Tx when high level of clinical suspicion. Bleeding: 0.6-4% Early Bleeding: •Etlg: d/t staple lines / surgical anastamosis •Mainly intraluminal PW:Melena, HR↑, HGB↓ •Self limited Tx: PC, reverse anticoagulation, EGD, Surgery. Early Complications - RYGB
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Leaks: 2-3 % –Account for 50% of mortality. –PW: fever, HR↑, resp. fail. Dx: UGIS, CT. Tx: A. Urgent Exploratory surgery: »1. Irrigation. »2. Repair of the defect. »3. Wide ext. drainage. B. Abx. Early Complications - RYGB
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Gastric remnant distention: rare Potentially lethal (distention->rupture->peritonitis) –Etlg: Blind pouch distention d/t ileus or mech. obstruction. –PW: pain, hiccups, LUQ tympany, shoulder pain, abdominal distension, tachycardia, or SOB. X-Ray: large gastric air bubble. Tx: decompression with gastrostomy (OR/Percutaneous) Early Complications - RYGB
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Wound Infection : Lap 3-4% –Open 10-15% –PW: fever, fluctuance, erythema, or drainage. Early Complications - RYGB
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Late complications(7wks-12mo)
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Band Erosion : 0-3% Etlg: gast wall ischemia (tight band, band buckle trauma). –PW: loss of restriction, fever, NV, + Port site infection ( B.K ). –Dx: EGD. Tx: removal. Band slippage/prolapse : 2-14% –PW: gastric obst (food intol, epig pain, NV). Dx: UGIS (band malposition, dilated/prolapsed gast. pouch) Tx: surgical reposition/removal. Late Complications - LAGB
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Port/tube Malfunction : 0.4-7% Etlg: disconnection, port flips, leakage. –PW: weight regain. Tx: surg repair/exchange hardware. Pouch/esophageal dilation (pseudoachalasia synd) : 10% Etlg: tight band, food intake↑, binge eating. –Tx: band deflation, band relocation/removal. Esophagitis: rare –Tx: deflation, acid supp., removal. Late Complications - LAGB
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Complications of Bariatric Surgery - ESadot - Complications...

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