Complications in Batriatric Surgery


Bariatric surgery is increasingly being performed in the medically complicated obese population as convincing data continue to mount, documenting the success of surgery not only in achieving meaningful weight loss but also in correcting obesity-related illnesses. Several surgical procedures with varying degrees of success and complications are currently being performed. This article discusses the short- and long-term gastrointestinal complications for the  most common bariatric surgical procedures: laparoscopic adjustable gastric banding, vertical sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch.

Bariatric surgery is increasingly being accepted as a viable treatment for managing the growing obesity epidemic. Surgery can provide a sustainable, long-term option for weight loss. The National Health and Nutrition Examination Survey from the Centers for Disease Control and Prevention revealed that the prevalence of obesity in adults (20-74 years) had more than doubled from 13.3% to 31.1% of the population from 1960 to 2002. The prevalence of obesity (body mass index [BMI] ≥30 kg/m2) has since stabilized at 35% in the United States starting in 2003. However, it is estimated that only 1% of eligible patients are undergoing surgical intervention. One barrier to accepting surgery may be the false notion of unacceptable risks and high rate of complications associated with surgery.

Obesity is associated with multiple medical comorbidities, including type 2 diabetes mellitus, cardiovascular disease, dyslipidemia, hypertension, cholelithiasis, gastroesophageal reflux disease, obstructive sleep apnea, degenerative joint disease, lower back pain, and cancer. In addition, obesity is associated with an increase in early mortality.7 The estimated number of annual deaths attributed to obesity in US adults is 280,000.10. In 1991, the National Institutes of Health consensus panel developed a set of recommendations regarding which patients should be considered for bariatric surgery. These recommendations included the criteria that patients have a calculated BMI of at least 40 kg/m2 or a BMI of at least 35 kg/m2 with significant obesity-related comorbidities. Since these guidelines have been released, the number of bariatric surgeries has increased 6-fold to more than 100,000 per year in 2003. But has subsequently reached a steady state of almost 350,000 operations each year. Along with the increased volume of surgical procedures, a dramatic decrease in mortality and complications related to surgical intervention has been achieved, as demonstrated in a recent meta-analysis showing a mortality rate of 0.08% within 30 days and 0.31% after 30 days. Complication rates from bariatric operations have progressively fallen from 10.5% of cases in 1993 to 7.6% of cases in 2006, with the majority of complications now being minor.Bariatric surgery has now been shown to provide long-term weight loss and to decrease overall mortality in obese patients compared with matched controls. The surgical weight loss mechanism is generally considered to involve restriction, malabsorption, or a combination of these mechanisms. Restrictive procedures decrease the size of the stomach, resulting in early satiety and decreased caloric intake. The operations performed include laparoscopic adjustable gastric banding (LAGB) and vertical sleeve gastrectomy .In contrast, malabsorptive procedures decrease the degree of small intestinal absorption of nutrients by bypassing a large portion of the small intestine. These procedures include biliopancreatic diversion with or without a duodenal switch . A bariatric procedure with both components, malabsorption and restriction, is Roux-en-Y gastric bypass which has been the most commonly performed bariatric procedure in the United States. Although all 4 procedures can be beneficial to patients, the operations have varying degrees of success and complication profiles that are unique to each procedure. This article will discuss the common gastrointestinal (GI) complications seen with each technique.

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Richard Potvin

Managing Editor 

General Surgery: Open Access