PECULIARITIES OF DIAGNOSTICS AND THERAPEUTIC TACTICS IN BLEEDING IN THE EARLY POSTOPERATIVE PERIOD AFTER BARIATRIC SURGERIES

Abstract

Methods. We retrospectively analyzed the results of diagnostics and treatment of 14 patients who had internal bleeding in the early postoperative period after bariatric surgeries. The following parameters were studied: age and sex of the patients, average body mass index, comorbidities, volume of the performed bariatric surgery, type of internal bleeding (intraluminal/intra-abdominal), technical peculiarities of each operation, average postoperative bed-day, efficiency of instrumental diagnostic methods, types and methods of hemostasis. Results. Clinical manifestations of bleeding in all patients operated on for morbid obesity were detected on 1-2 postoperative days. The main symptoms: weakness and dizziness - in 12 cases (86%), BP decrease up to 90±60 mmHg. - in 4 (28%), tachycardia (HR 100 and more beats per minute) - in 100% of cases. Development of melena and vomiting with blood admixture was noted in 6 (42%) cases, blood flow by drainage - in 8 (58%). In 4 patients (28%) the development of bleeding was preceded by BP increase up to 180-200/100-110 mmHg. In all 14 patients hemoglobin level decreased: in 6 (42%) not lower than 100g/L (but more than 20% of the initial hemoglobin level), and in 8 (58%) - below 100g/L. Esophagogastroduodenoscopy (EGDS) was used to diagnose bleeding inside the lumen of the stomach, intestine, anastomosis, and computerized tomography (CT) of the abdominal cavity with intravenous and oral contrast for intra-abdominal bleeding. In 6 patients with intra-abdominal bleeding revision laparoscopy was performed as an emergency procedure. When the source of bleeding from the stapler line was revealed, the bleeding zone was additionally sutured with Vicryl 3\0 thread using separate knotted sutures. In case of bleeding from the trocar wound, hemostasis was performed with the help of Bersi needle using 1/0 capron thread.No lethal outcomes were observed. All patients were discharged in satisfactory condition. The average bed-day due to the complication increased on average by 2-3 days. Conclusion. Effective methods of diagnostics and treatment of intraluminal bleedings are endoscopic techniques with the possibility of reliable hemostasis. In case of intra-abdominal bleeding relaparoscopy with stitching or clipping of the bleeding source is shown.