Skip to main content

Hemorrhage after Bariatric Surgery: Evaluation and Management

  • Chapter
  • First Online:
Bariatric Surgery Complications and Emergencies

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. 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.

    Article  PubMed  Google Scholar 

  2. Nguyen NT, Rivers R, Wolfe BM. Early gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg. 2003;13(1):62–5.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  CAS  PubMed  Google Scholar 

  5. Bransen J, Gilissen LPL, van Rutte PWJ, Nienhuijs SW. Costs of leaks and bleeding after sleeve gastrectomies. Obes Surg. 2015;25(10):1767–71.

    Article  PubMed  Google Scholar 

  6. Frezza EE, Reddy S, Gee LL, Wachtel MS. Complications after sleeve gastrectomy for morbid obesity. Obes Surg. 2009;19(6):684–7.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  8. Schauer PR, Schirmer BD, Brethauer S. Minimally invasive bariatric surgery. New York: Springer Science & Business Media; 2008. p. 370. Chapter 24; 516 p.

    Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. Campos GM, et al. Spectrum and risk factors of complications after gastric bypass. Arch Surg. 2007;142:969–75. discussion 976.

    Article  PubMed  Google Scholar 

  12. Varela JE, Wilson SE, Nguyen NT. Outcomes of bariatric surgery in the elderly. Am Surg. 2006;72:865–9.

    PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. Parikh J, et al. Is high BMI associated with specific complications after laparoscopic Roux-en-Y gastric bypass? Am Surg. 2007;73:959–62.

    PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  CAS  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. Schauer PR, Schirmer BD, Brethauer S. Minimally invasive bariatric surgery. New York: Springer Science & Business Media; 2008. p. 275. Cap.21.5; 516 p.

    Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. Rogula T, Yenumula PR, Schauer PR. A complication of Roux-en-Y gastric bypass: intestinal obstruction. Surg Endosc. 2007;21(11):1914–8.

    Article  CAS  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. Torrens AS, Born PW, Naver L. Gastric blow-out: complication after obesity surgery. Ugeskr Laeger. 2009;171(49):3624–5.

    PubMed  Google Scholar 

  27. Braley SC, Nguyen NT, Wolfe BM. Late gastrointestinal hemorrhage after gastric bypass. Obes Surg. 2002;12(3):404–7.

    Article  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  CAS  PubMed  Google Scholar 

  32. Kazemier G, Hazebroek EJ, Lange JF, Bonjer HJ. Needle and trocar injury during laparoscopic surgery in Japan. Surg Endosc. 1999;13(2):194.

    Article  CAS  PubMed  Google Scholar 

  33. 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.

    Article  CAS  PubMed  Google Scholar 

  34. 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.

    PubMed  Google Scholar 

  35. 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.

    Article  PubMed  Google Scholar 

  36. Cogbill, TH. Abnormal operative and postoperative bleeding. In: Current surgical therapy. 10th Edition, Cameron, JH. Philadelphia, PA: 2010; Elsevier; p.1090.

    Google Scholar 

  37. 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.

    Article  Google Scholar 

  38. http://ether.stanford.edu/calc_mabl.html

  39. Nguyen NT, Longoria M, Chalifoux S, Wilson SE. Gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg. 2004;14(10):1308–12.

    Article  PubMed  Google Scholar 

  40. 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.

    Article  PubMed  Google Scholar 

  41. 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.

    Article  PubMed  Google Scholar 

  42. 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/.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 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.

    Article  PubMed  Google Scholar 

  44. 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.

    Article  CAS  PubMed  Google Scholar 

  45. Flickinger EG, Sinar DR, Pories WJ, Sloss RR, Park HK, Gibson JH. The bypassed stomach. Am J Surg. 1985;149(1):151–6.

    Article  CAS  PubMed  Google Scholar 

  46. 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.

    Article  CAS  PubMed  Google Scholar 

  47. 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.

    Article  PubMed  Google Scholar 

  48. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  49. 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.

    Article  PubMed  Google Scholar 

  50. Schauer PR, Schirmer BD, Brethauer S. Minimally invasive bariatric surgery. New York: Springer Science & Business Media; 2008. p. 292. Chapter 21.7; 516 p.

    Google Scholar 

  51. 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.

    Article  PubMed  Google Scholar 

  52. 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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tomasz Rogula MD, PhD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

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

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-27114-9_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27112-5

  • Online ISBN: 978-3-319-27114-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics