Abstract
Bariatric surgery is an increasingly common treatment for morbid obesity [1], because it is the only technique with demonstrated efficacy in terms of long-term, sustained weight loss. Most studies have shown that these operations are safe, with decreased overall mortality and morbidity, and reversal of related comorbidities in obese patients. However, the beneficial effects of bariatric surgery need to be weighed against the risks of perioperative complications and postoperative or short-term adverse outcomes [2].
From the intensive care unit (ICU) physician’s perspective, these patients represent new and challenging issues and raise specific concerns. Several medical postoperative complications may require ICU admission, the most common being acute respiratory failure and thromboembolic disease with deep vein thrombosis and pulmonary embolism. Surgical complications are specific to the procedure performed, but anastomotic leaks are probably the most common life-threatening events [3, 4]. The purpose of this chapter is to review the surgical complications most commonly observed during bariatric surgery in order to help surgeons and ICU physicians provide high-quality care for these high-risk patients.
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References
DeMaria EJ (2007) Bariatric surgery for morbid obesity. N Engl J Med 356:2176–2183
Buchwald H, Avidor Y, Braunwald E et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737
Fernandez AZ Jr., Tichansky DS, Demaria EJ et al (2004) Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg 239:698–702
Morino M, Toppino M, Forestieri P et al (2007) Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry. Ann Surg 246:1002–1007
Gagner M, Boza C (2006) Laparoscopic duodenal switch for morbid obesity. Exp Rev Med Devices 3:105–112
Al-Sabah S, Ladouceur M, Christou N (2008) Anastomotic leaks after bariatric surgery: it is the host response that matters. Surg Obes Relat Dis 4:152–157
Ballesta C, Berindoague R, Cabrera M, Palau M, Gonzales M (2008) Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass. Obes Surg 18:623–630
Thodiyil PA, Yenumula P, Rogula T et al (2008) Selective nonoperative management of leaks after gastric bypass: lessons learned from 2,675 consecutive patients. Ann Surg 248:782–792
Flum DR, Belle SH, King WC et al (2009) Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 361:445–454
Dillemans B, Sakran N, Van Cauwenberge S et al (2009) Standardization of the fully stapled laparoscopic Roux-en-Y gastric bypass for obesity reduces early immediate postoperative morbidity and mortality: a single center study on 2,606 patients. Obes Surg 19:1355–1364
Chen CC, Huang MT, Wei PL et al (2010) Severe peritonitis due to Streptococcus viridans following adjustable gastric banding. Obes Surg 20:1603–1605
Benotti PN, Wood GC, Rodriguez H, Carnevale N, Liriano E (2006) Perioperative outcomes and risk factors in gastric surgery for morbid obesity: a 9-year experience. Surgery 139:340–346
van den Broek RJ, Buise MP, van Dielen FM et al (2009) Characteristics and outcome of patients admitted to the ICU following bariatric surgery. Obes Surg 19:560–564
Gonzalez R, Nelson LG, Gallagher SF, Murr MM (2004) Anastomotic leaks after laparoscopic gastric bypass. Obes Surg 14:1299–1307
Goldfeder LB, Ren CJ, Gill JR (2006) Fatal complications of bariatric surgery. Obes Surg 16:1050–1056
Chapman AE, Kiroff G, Game P et al (2004) Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery 135:326–351
Owers C, Ackroyd R (2013) A study examining the complications associated with gastric banding. Obes Surg 23:56–59
Agence Nationale d’Accréditation et d’Evaluation en Santé. Service évaluation des technologies (2001) Chirurgie de l’obésité morbide de l’adulte. Available at: http://prod1-has-portail.integra.fr/portail/upload/docs/application/pdf/chirurgie_obesite_rap.pdf. Accessed September 2013
Shi X, Karmali S, Sharma AM, Birch DW (2010) A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg 20:1171–1177
Parikh M, Issa R, McCrillis A et al (2013) Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9,991 cases. Ann Surg 257:231–237
Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I (2007) Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery 142:621–632
Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT (2003) Complications after laparoscopic gastric bypass: a review of 3,464 cases. Arch Surg 138:957–961
Gonzalez R, Sarr MG, Smith CD et al (2007) Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg 204:47–55
Heneghan HM, Meron-Eldar S, Yenumula P et al (2012) Incidence and management of bleeding complications after gastric bypass surgery in the morbidly obese. Surg Obes Relat Dis 8:729–735
Mehran A, Liberman M, Rosenthal R, Szomstein S (2003) Ruptured appendicitis after laparoscopic Roux-enY gastric bypass: pitfalls in diagnosing a surgical abdomen in the morbidly obese. Obes Surg 13:938–940
Montravers P, Guglielminotti J, Zappella N et al (2013) Clinical features and outcome of postoperative peritonitis following bariatric surgery. Obes Surg 23:1536–1544
Hamilton EC, Sims TL, Hamilton TT et al (2003) Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc 17:679–684
Kermarrec N, Marmuse JP, Faivre J et al (2008) High mortality rate for patients requiring intensive care after surgical revision following bariatric surgery. Obes Surg 18:171–178
Merkle EM, Hallowell PT, Crouse C et al (2005) Roux-en-Y gastric bypass for clinically severe obesity: normal appearance and spectrum of complications at imaging. Radiology 234:674–683
Madan AK, Stoecklein HH, Ternovits CA et al (2007) Predictive value of upper gastrointestinal studies versus clinical signs for gastrointestinal leaks after laparoscopic gastric bypass. Surg Endosc 21:194–196
Lyass S, Khalili TM, Cunneen S et al (2004) Radiological studies after laparoscopic Roux-en-Y gastric bypass: routine or selective? American Surg 70:918–921
Pequignot A, Fuks D, Verhaeghe P et al (2012) Is there a place for pigtail drains in the management of gastric leaks after laparoscopic sleeve gastrectomy? Obes Surg 22:712–720
Moszkowicz D, Arienzo R, Khettab I et al (2013) Sleeve gastrectomy severe complications: is it always a reasonable surgical option? Obes Surg 23:676–686
Choban PS, Dickerson RN (2005) Morbid obesity and nutrition support: is bigger different? Nutr Clin Pract 20:480–487
Ishida RK, Faintuch J, Paula AM et al (2007) Microbial flora of the stomach after gastric bypass for morbid obesity. Obes Surg 17:752–758
Rebibo L, Dupont H, Levrard M et al (2013) Letter to Editor: "Gastric fistula after laparoscopic sleeve gastrectomy: Don't forget to treat for candida". Obes Surg 23:2106–2108
Hites M, Taccone FS, Wolff F et al (2013) Case-control study of drug monitoring of beta-lactams in obese critically ill patients. Antimicrob Agents Chemother 57:708–715
Khan MA, Grinberg R, Johnson S, Afthinos JN, Gibbs KE (2013) Perioperative risk factors for 30-day mortality after bariatric surgery: is functional status important? Surg Endosc 27:1772–1777
Fernandez AZ Jr, DeMaria EJ, Tichansky DS et al (2004) Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc 18:193–197
Hutagalung R, Marques J, Kobylka K et al (2011) The obesity paradox in surgical intensive care unit patients. Intensive Care Med 37:1793–1799
Sakr Y, Madl C, Filipescu D et al (2008) Obesity is associated with increased morbidity but not mortality in critically ill patients. Intensive Care Med 34:1999–2009
Nasraway SA Jr, Albert M, Donnelly AM et al (2006) Morbid obesity is an independent determinant of death among surgical critically ill patients. Crit Care Med 34:964–970
Bercault N, Boulain T, Kuteifan K et al (2004) Obesity-related excess mortality rate in an adult intensive care unit: a risk-adjusted matched cohort study. Crit Care Med 32:998–1003
Ray DE, Matchett SC, Baker K et al (2005) The effect of body mass index on patient outcomes in a medical ICU. Chest 127:2125–2131
Pasulka PS, Bistrian BR, Benotti PN, Blackburn GL (1986) The risks of surgery in obese patients. Ann Intern Med 104:540–546
Akinnusi ME, Pineda LA, El Solh AA (2008) Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med 36:151–158
Csendes A, Burdiles P, Burgos AM, Maluenda F, Diaz JC (2005) Conservative management of anastomotic leaks after 557 open gastric bypasses. Obes Surg 15:1252–1256
Papasavas PK, Caushaj PF, McCormick JT et al (2003) Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc 17:610–614
Marshall JS, Srivastava A, Gupta SK, Rossi TR, DeBord JR (2003) Roux-en-Y gastric bypass leak complications. Arch Surg 138:520–523
Lee S, Carmody B, Wolfe L et al (2007) Effect of location and speed of diagnosis on anastomotic leak outcomes in 3,828 gastric bypass cases. J Gastrointest Surg 11:708–713
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Montravers, P., Fournier, P., Augustin, P. (2014). Surgical Complications Following Bariatric Surgery. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2014. Annual Update in Intensive Care and Emergency Medicine, vol 2014. Springer, Cham. https://doi.org/10.1007/978-3-319-03746-2_37
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DOI: https://doi.org/10.1007/978-3-319-03746-2_37
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