Abstract and Introduction
Abstract
Purpose of review: Morbid obesity is an epidemic in the United States and parts of Europe, with severe health consequences. As the number of patients undergoing bariatric surgery has increased dramatically, it is crucial for the gastroenterologist caring for these patients to have a better understanding of the procedures, their unique complications and the proper management for these complications.
Recent findings: The incidence of the most significant complications is calculated from recent publications. Radiological and endoscopic workup is useful for diagnosis. Endoscopic dilation of strictures is possible. Endoscopic intervention for selected leaks and fistulas has been reported.
Summary: This review describes the most common types of bariatric surgery, discusses the complications that each can cause, and addresses the recommended approach for their work-up and management in order to better equip the gastroenterologist in dealing with this new field.
Introduction
Morbid obesity is a common problem in developed countries with severe health consequences, including diabetes, cardiovascular disease, arthritis, obstructive sleep apnea, obesity hypoventilation syndrome, and increased risk of cancer. Conservative therapy, including behavior modification and medications, is less effective than bariatric surgery in sustaining weight loss. In addition, bariatric surgery produced a 50% mortality reduction in a nonrandomized, epidemiologic study of 1020 patients followed for 9 years (P = 0.04).
The goal of bariatric surgery is to reduce caloric intake by either restricting the amount of calories an individual can take in (restrictive procedure) or reducing the amount of calories absorbed from the gastrointestinal tract (malab-sorptive procedure). This can be accomplished in a number of ways. The most commonly described techniques are the Roux-en-Y gastric bypass (RYGBP) (restrictive and some malabsorptive), laparoscopic adjustable banding (LAGB) (restrictive only), and the biliary-pancreatico diversion with duodenal switch (BPD/DS) (malabsorptive and some restrictive).
Although the procedures can be successful, they are technically difficult and can be associated with a number of complications. Unfortunately, these complications can sometimes be subtle and difficult to diagnose early. For example, tachycardia greater than 120 bpm may be the most reliable sign of intra-abdominal sepsis from a surgical leak or abscess. Since these patients have limited physiologic reserve, it is imperative that complications are identified early and appropriately managed.
The first part of the manuscript will be a brief description of the anatomical changes resulting from these procedures and the potential complications unique to each. The second part of the manuscript will discuss how these potential complications can present and how they should be evaluated. The third part of the manuscript will discuss management of surgical complications. We will close this manuscript by speculating on the potential future directions of this field.