Abstract
While bleeding is an infrequent complication in bariatric surgery, it has the potential to pose a significant risk to the patient of serious morbidity and even mortality. Patient risk factors, type of surgery performed, and prevention methods can influence the incidence of perioperative and postoperative bleeding. Its management may require a combined multidisciplinary approach that must be modified depending on the patient’s hemodynamic state. This chapter aims to describe effective management strategies for bleeding, as well as to aid the surgeon’s ability to recognize risk factors, diagnose and prevent this complication.
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References
Heneghan HM, Meron-Eldar S, Yenumula P, Rogula T, Brethauer SA, Schauer PR. Incidence and management of bleeding complications after gastric bypass surgery in the morbidly obese. Surg Obes Relat Dis. 2012;8(6):729–35.
Nguyen NT, Rivers R, Wolfe BM. Early gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg. 2003;13(1):62–5.
Dick A, Byrne TK, Baker M, Budak A, Morgan K. Gastrointestinal bleeding after gastric bypass surgery: nuisance or catastrophe? Surg Obes Relat Dis. 2010;6(6):643–7.
Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients--what have we learned? Obes Surg. 2000;10(6):509–13.
Bransen J, Gilissen LPL, van Rutte PWJ, Nienhuijs SW. Costs of leaks and bleeding after sleeve gastrectomies. Obes Surg. 2015;25(10):1767–71.
Frezza EE, Reddy S, Gee LL, Wachtel MS. Complications after sleeve gastrectomy for morbid obesity. Obes Surg. 2009;19(6):684–7.
Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5(4):469–75.
Schauer PR, Schirmer BD, Brethauer S. Minimally invasive bariatric surgery. New York: Springer Science & Business Media; 2008. p. 370. Chapter 24; 516 p.
Rosenthal RJ, Szomstein S, Kennedy CI, Soto FC, Zundel N. Laparoscopic surgery for morbid obesity: 1,001 consecutive bariatric operations performed at The Bariatric Institute, Cleveland Clinic Florida. Obes Surg. 2006;16(2):119–24.
Rabl C, et al. Early and late abdominal bleeding after Roux-en-Y gastric bypass: sources and tailored therapeutic strategies. Obes Surg. 2011;21:413–20.
Campos GM, et al. Spectrum and risk factors of complications after gastric bypass. Arch Surg. 2007;142:969–75. discussion 976.
Varela JE, Wilson SE, Nguyen NT. Outcomes of bariatric surgery in the elderly. Am Surg. 2006;72:865–9.
Bakhos C, Alkhoury F, Kyriakides T, Reinhold R, Nadzam G. Early postoperative hemorrhage after open and laparoscopic roux-en-y gastric bypass. Obes Surg. 2009;19:153–7.
Parikh J, et al. Is high BMI associated with specific complications after laparoscopic Roux-en-Y gastric bypass? Am Surg. 2007;73:959–62.
Mourelo R, Kaidar-Person O, Fajnwaks P, Roa PE, Pinto D, Szomstein S, Rosenthal RJ. Hemorrhagic and thromboembolic complications after bariatric surgery in patients receiving chronic anticoagulation therapy. Obes Surg. 2008;18(2):167–70.
Birkmeyer NJO, Finks JF, Carlin AM, Chengelis DL, Krause KR, Hawasli AA, et al. Comparative effectiveness of unfractionated and low-molecular-weight heparin for prevention of venous thromboembolism following bariatric surgery. Arch Surg. 2012;147(11):994–8.
Ikesaka R, Delluc A, Le Gal G, Carrier M. Efficacy and safety of weight-adjusted heparin prophylaxis for the prevention of acute venous thromboembolism among obese patients undergoing bariatric surgery: a systematic review and meta-analysis. Thromb Res. 2014;133(4):682–7.
Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003;138(9):957–61.
Topart P, Becouarn G, Ritz P. Comparative early outcomes of three laparoscopic bariatric procedures: sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis. 2012;8(3):250–4.
Weiner RA, El-Sayes IA, Theodoridou S, Weiner SR, Scheffel O. Early post-operative complications: incidence, management, and impact on length of hospital stay. A retrospective comparison between laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg. 2013;23(12):2004–12.
Schauer PR, Schirmer BD, Brethauer S. Minimally invasive bariatric surgery. New York: Springer Science & Business Media; 2008. p. 275. Cap.21.5; 516 p.
Bailey JG, Hayden JA, Davis PJB, Liu RY, Haardt D, Ellsmere J. Robotic versus laparoscopic Roux-en-Y gastric bypass (RYGB) in obese adults ages 18 to 65 years: a systematic review and economic analysis. Surg Endosc. 2014 Feb;28(2):414–26.
Mala T, Søvik TT, Schou CF, Kristinsson J. Blood clot obstruction of the jejunojejunostomy after laparoscopic gastric bypass. Surg Obes Relat Dis. 2013;9(2):234–7.
Rogula T, Yenumula PR, Schauer PR. A complication of Roux-en-Y gastric bypass: intestinal obstruction. Surg Endosc. 2007;21(11):1914–8.
Gunabushanam G, Shankar S, Czerniach DR, Kelly JJ, Perugini RA. Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass surgery. J Comput Assist Tomogr. 2009;33(3):369–75.
Torrens AS, Born PW, Naver L. Gastric blow-out: complication after obesity surgery. Ugeskr Laeger. 2009;171(49):3624–5.
Braley SC, Nguyen NT, Wolfe BM. Late gastrointestinal hemorrhage after gastric bypass. Obes Surg. 2002;12(3):404–7.
Huang CS, Forse RA, Jacobson BC, Farraye FA. Endoscopic findings and their clinical correlations in patients with symptoms after gastric bypass surgery. Gastrointest Endosc. 2003;58(6):859–66. http://www.giejournal.org/article/S0016510703023101/abstract.
Bellorin O, Abdemur A, Sucandy I, Szomstein S, Rosenthal RJ. Understanding the significance, reasons and patterns of abnormal vital signs after gastric bypass for morbid obesity. Obes Surg. 2011;21(6):707–13.
Azevedo JLMC, Azevedo OC, Miyahira SA, Miguel GPS, Becker OM, Hypólito OHM, et al. Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review. Surg Endosc. 2009;23(7):1428–32.
Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg. 1993;165(1):9–14.
Kazemier G, Hazebroek EJ, Lange JF, Bonjer HJ. Needle and trocar injury during laparoscopic surgery in Japan. Surg Endosc. 1999;13(2):194.
Champault G, Cazacu F, Taffinder N. Serious trocar accidents in laparoscopic surgery: a French survey of 103,852 operations. Surg Laparosc Endosc. 1996;6(5):367–70.
Sharp HT, Dodson MK, Draper ML, Watts DA, Doucette RC, Hurd WW. Complications associated with optical-access laparoscopic trocars. Obstet Gynecol. 2002;99(4):553–5.
Sundbom M, Hedberg J, Wanhainen A, Ottosson J. Aortic injuries during laparoscopic gastric bypass for morbid obesity in Sweden 2009–2010: a nationwide survey. Surg Obes Relat Dis. 2014;10(2):203–7.
Cogbill, TH. Abnormal operative and postoperative bleeding. In: Current surgical therapy. 10th Edition, Cameron, JH. Philadelphia, PA: 2010; Elsevier; p.1090.
American Society of Anesthesiologists Task Force on Perioperative Blood Management. Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management. Anesthesiology. 2015;122(2):241–75.
Nguyen NT, Longoria M, Chalifoux S, Wilson SE. Gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg. 2004;14(10):1308–12.
Moretto M, Mottin CC, Padoin AV, Berleze D, Repetto G. Endoscopic management of bleeding after gastric bypass -- a therapeutic alternative. Obes Surg. 2004;14(5):706.
Santo MA, Pajecki D, Riccioppo D, Cleva R, Kawamoto F, Cecconello I. Early complications in bariatric surgery: incidence, diagnosis and treatment. Arq Gastroenterol. 2013;50(1):50–5.
Gill KR, McKinney JM, Stark ME, Bouras EP. Investigation of the excluded stomach after Roux-en-Y gastric bypass: the role of percutaneous endoscopy. World J Gastroenterol. 2008;14(12):1946–8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2700407/.
Tagaya N, Kasama K, Inamine S, Zaha O, Kanke K, Fujii Y, et al. Evaluation of the excluded stomach by double-balloon endoscopy after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17(9):1165–70.
Sakai P, Kuga R, Safatle-Ribeiro AV, Faintuch J, Gama-Rodrigues JJ, Ishida RK, et al. Is it feasible to reach the bypassed stomach after Roux-en-Y gastric bypass for morbid obesity? The use of the double-balloon enteroscope. Endoscopy. 2005;37(6):566–9.
Flickinger EG, Sinar DR, Pories WJ, Sloss RR, Park HK, Gibson JH. The bypassed stomach. Am J Surg. 1985;149(1):151–6.
Sinar DR, Flickinger EG, Park HK, Sloss RR. Retrograde endoscopy of the bypassed stomach segment after gastric bypass surgery: unexpected lesions. South Med J. 1985;78(3):255–8.
D’Ugo S, Gentileschi P, Benavoli D, Cerci M, Gaspari A, Berta RD, et al. Comparative use of different techniques for leak and bleeding prevention during laparoscopic sleeve gastrectomy: a multicenter study. Surg Obes Relat Dis. 2014;10(3):450–4.
Shah SS, Todkar JS, Shah PS. Buttressing the staple line: a randomized comparison between staple-line reinforcement versus no reinforcement during sleeve gastrectomy. Obes Surg. 2014;24(12):2014–20.
Choi YY, Bae J, Hur KY, Choi D, Kim YJ. Reinforcing the staple line during laparoscopic sleeve gastrectomy: does it have advantages? A meta-analysis. Obes Surg. 2012;22(8):1206–13.
Schauer PR, Schirmer BD, Brethauer S. Minimally invasive bariatric surgery. New York: Springer Science & Business Media; 2008. p. 292. Chapter 21.7; 516 p.
Dallal RM, Bailey L, Nahmias N. Back to basics--clinical diagnosis in bariatric surgery. Routine drains and upper GI series are unnecessary. Surg Endosc. 2007;21(12):2268–71.
Liscia G, Scaringi S, Facchiano E, Quartararo G, Lucchese M. The role of drainage after Roux-en-Y gastric bypass for morbid obesity: a systematic review. Surg Obes Relat Dis. 2014;10(1):171–6.
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Mejia, I.A.Z., Rogula, T. (2016). Hemorrhage after Bariatric Surgery: Evaluation and Management. In: Herron, D. (eds) Bariatric Surgery Complications and Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-27114-9_5
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DOI: https://doi.org/10.1007/978-3-319-27114-9_5
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