Management of Complications of Bariatric Operations

  • Aftab Jafri
  • Emanuele Lo Menzo
  • Samuel Szomstein
  • Raul J. RosenthalEmail author


Bariatric operations are highly effective at achieving significant weight loss and improvement in comorbidities associated with obesity. Along with the increased number of operations, complications will increase. In this chapter, we discuss complications encountered after the most common bariatric operations. Complications should be expected to be seen more frequently as the number of patients who undergo weight loss surgery rise. It is therefore important for general surgeons to have an understanding of the common bariatric procedures and their complications.


Gastric bypass Gastric sleeve Anastomotic leak Gastric stenosis Morbid obesity Marginal ulcers 


Conflicts of Interest

The authors have no conflicts of interest to declare.


  1. 1.
    Gastrointestinal surgery for severe obesity. Consens Statement. 1991;9(1):1–20. Review.Google Scholar
  2. 2.
    Grabovac I, Smith L, Stefanac S, Haider S, Cao C, Waldhoer T, Jackson SE, Yang L. Healthcare providers’ advice on lifestyle modification in the US population: results from the National Health and Nutrition Examination Survey 2011–2016. Am J Med. 2018;132(4):489–497.e1.CrossRefGoogle Scholar
  3. 3.
    Azagury D, Papasavas P, Hamdallah I, Gagner M, Kim J. ASMBS Position Statement on medium- and long-term durability of weight loss and diabetic outcomes after conventional stapled bariatric procedures. Surg Obes Relat Dis. 2018;14:1425–41.CrossRefGoogle Scholar
  4. 4.
    Lo Menzo E, Szomstein S, Rosenthal R. Update on treatment of morbid obesity with adjustable gastric banding. Surg Clin North Am. 2016;96(4):795–813. Review.CrossRefPubMedGoogle Scholar
  5. 5.
    Cherian PT, Goussous G, Ashori F, Sigurdsson A. Band erosion after laparoscopic gastric banding: a retrospective analysis of 865 patients over 5 years. Surg Endosc. 2010;24(8):2031–8.CrossRefGoogle Scholar
  6. 6.
    Noel P, Nedelcu M, Gagner M. Impact of the surgical experience on leak rate after laparoscopic sleeve Gastrectomy. Obes Surg. 2016;26(8):1782–7.CrossRefGoogle Scholar
  7. 7.
    Court I, Wilson A, Benotti P, Szomstein S, Rosenthal RJ. T-tube gastrostomy as a novel approach for distal staple line disruption after sleeve gastrectomy for morbid obesity: case report and review of the literature. Obes Surg. 2010;20(4):519–22.CrossRefGoogle Scholar
  8. 8.
    Sasson M, Ahmad H, Dip F, Lo Menzo E, Szomstein S, Rosenthal RJ. Comparison between major and minor surgical procedures for the treatment of chronic staple line disruption after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(5):969–75.CrossRefGoogle Scholar
  9. 9.
    Mahadev S, Kumbhari V, Campos JM, Galvao Neto M, Khashab MA, Chavez YH, Bessler M, Gonda TA. Endoscopic septotomy: an effective approach for internal drainage of sleeve gastrectomy-associated collections. Endoscopy. 2017;49(5):504–8.CrossRefGoogle Scholar
  10. 10.
    Dapri G, Cadière GB, Himpens J. Laparoscopic seromyotomy for long stenosis after sleeve gastrectomy with or without duodenal switch. Obes Surg. 2009;19(4):495–9.CrossRefGoogle Scholar
  11. 11.
    Ballesta C, Berindoague R, Cabrera M, Palau M, Gonzales M. Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(6):623–30.CrossRefGoogle Scholar
  12. 12.
    Gonzalez R, Sarr MG, Smith CD, Baghai M, Kendrick M, Szomstein S, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg. 2007;204(1):47–55.CrossRefGoogle Scholar
  13. 13.
    Cucchi SG, Pories WJ, MacDonald KG, Morgan EJ. Gastrogastric fistulas. A complication of divided gastric bypass surgery. Ann Surg. 1995;221(4):387–91.CrossRefGoogle Scholar
  14. 14.
    Salimath J, Rosenthal RJ, Szomstein S. Laparoscopic remnant gastrectomy as a novel approach for treatment of gastrogastric fistula. Surg Endosc. 2009;23(11):2591–5.CrossRefGoogle Scholar
  15. 15.
    Cho M, Kaidar-Person O, Szomstein S, Rosenthal RJ. Laparoscopic remnant gastrectomy: a novel approach to gastrogastric fistula after Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg. 2007;204(4):617–24.CrossRefGoogle Scholar
  16. 16.
    Rosenthal RJ. Dilating the stenotic gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass for morbid obesity: when things go wrong. J Gastrointest Surg. 2009;13(9):1561–3.CrossRefGoogle Scholar
  17. 17.
    Nimeri AA, Maasher A, Al Shaban T, Salim E, Gamaleldin MM. Internal hernia following laparoscopic Roux-en-Y gastric bypass: prevention and tips for intra-operative management. Obes Surg. 2016;26(9):2255–6. Ver Steeg KCrossRefGoogle Scholar
  18. 18.
    Owens M, Barry M, Janjua AZ, Winter DC. A systematic review of laparoscopic port site hernias in gastrointestinal surgery. Surgeon. 2011;9(4):218–24.CrossRefGoogle Scholar
  19. 19.
    Edwards MA, Grinbaum R, Ellesmere J, Jones DB, Schneider BE. Intussusception after Roux-en-Y gastric bypass for morbid obesity: case report and literature review of rare complication. Surg Obes Relat Dis. 2006;2(4):483–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Aftab Jafri
    • 1
  • Emanuele Lo Menzo
    • 1
  • Samuel Szomstein
    • 1
  • Raul J. Rosenthal
    • 1
    Email author
  1. 1.Department of General Surgery, The Metabolic and Bariatric Institute, Cleveland Clinic FloridaWestonUSA

Personalised recommendations