Abstract
It is becoming more common for surgeons to manage obese patients in the acute setting with non-bariatric surgical emergencies. Obesity presents a diagnostic challenge for the acute care surgeon. Given the emergent need for intervention and the subsequently minimized opportunity for preoperative selection and optimization, obese patients requiring emergency surgery represent a complex patient population at high risk for perioperative morbidity.
There is nothing unique about perforations of the upper gastrointestinal tract in the obese population versus other patients but there are specific additional considerations that the acute care surgeon should be aware of. It is particularly important that obese patients requiring emergency surgery are managed by an anesthetist experienced in the care of the obese along with an experienced surgeon in order to minimize the operative time and the risk of complications.
Bariatric surgical expertise seems to favorably impact hospital length of stay and the application of more minimally invasive approaches in cases not routinely done laparoscopically.
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References
Camilleri M, Malhi H, Acosta A. Gastrointestinal complications of obesity. Gastroenterology. 2017;152:1656–70.
Flint R. Differences in acute general surgical admissions between obese or overweight patients compared to normal-sized patients. N Z Med J. 2015;128:35–41.
Pakula A, Skinner R. Do acute care surgeons need bariatric surgical training to ensure optimal outcomes in obese patients with nonbariatric emergencies? Surg Obes Relat Dis. 2018;14:339–41.
Bernante P, Breda C, Zangrandi F, et al. Emergency sleeve gastrectomy as rescue treatment for acute gastric necrosis due to type II paraesophageal hernia in an obese woman with gastric banding. Obes Surg. 2008;18:737–41.
ASGE Standards of Practice Committee, Ben-Menachem T, Decker GA, Early DS, et al. Adverse events of upper GI endoscopy. Gastrointest Endosc. 2012;76:707–18.
Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc. 2009;70:80–8.
Bigolin AV, Rinaldi N, Menguer R, et al. Case report: are we prepared to manage acute abdomen in the super-obese patient? J Obes Overweight. 2017;3:105. https://doi.org/10.15744/2455-7633.3.105.
Kupper S, Karvellas CJ, Khadaroo RG, Widder SL. Increased health services use by severely obese patients undergoing emergency surgery: a retrospective color study. Can J Surg. 2015;58:41–7.
Brown CVR, Velmahos GC. The consequences of obesity on trauma, emergency surgery, and surgical critical care. World J Emerg Surg. 2006;1:27. https://doi.org/10.1186/1749-7922-1-27.
Jung Y. Management of gastrointestinal tract perforations. Gastrointest Interv. 2017;6:157–61.
Mennigen R, Senninger N, Laukoetter MG. Novel treatment options for perforations of the upper gastrointestinal tract: endoscopic vacuum therapy and over-the-scope clips. World J Gastroenterol. 2014;20:7767–76.
Pournaras DJ, Hardwick RH, Safranek PM, et al. Endoluminal Vacuum Therapy (E-Vac): a treatment option in oesophagogastric surgery. World J Surg. 2018;42:2507–11.
Negoi I, Beuran M, Ciubotaru C, et al. The laparoscopic approach in emergency surgery: a review of the literature. J Acute Dis. 2018;7:15–9.
Byrne BE, Bassett M, Rogers CA, et al. Short-term outcomes after emergency surgery for complicated peptic ulcer disease from the UK National Emergency Laparotomy Audit: a cohort study. BMJ Open. 2018;8:e023721. https://doi.org/10.1136/bmjopen-2018-023721.
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Bernante, P., Rottoli, M., Cariani, S., Balsamo, F., Poggioli, G. (2020). Perforations of the Upper Gastrointestinal Tract. In: Foschi, D., Navarra, G. (eds) Emergency Surgery in Obese Patients. Updates in Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-17305-0_7
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