Complications Of Bariatric Surgery Research Articles

Post bariatric surgery complications, nutritional and psychological status.

Bariatric surgery becomes the final option for managing severe obesity. This study aims to identify the complications, changes in anthropometry, adherence to dietary recommendations, and psychological well-being of post-bariatric surgery patients. An observational study was conducted on 63 post-bariatric surgery patients who had undergone bariatric surgery between two weeks and five years after surgery. The participants were assessed for the complications experienced, current comorbidities, anthropometric changes, dietary intake, and psychological well-being. A three-day, 24-hour diet recall was done to assess the dietary intake of the patients. The mean macronutrient and micronutrient intakes were compared to several available recommendations. The DASS-21 questionnaire was administered to determine the psychological well-being of the participants. The most common complications experienced by patients after bariatric surgery were hair loss (50.8%), gastroesophageal reflux disease (GERD) (49.2%), and vomiting (41.3%). There were significant differences in mean weight before (129.5 (33.0) kg/m2) and after (85.0 (32.0) kg/m2) bariatric surgery (p<0.001). The prevalence of clinically severe obesity declined by 55%. Overall, patients had insufficient intake of some nutrients such as protein, fat, calcium, and iron. Majority of the patients experienced a normal level of stress, anxiety, and depression, but some had mild (3.2%), moderate (4.8%), and severe anxiety (1.6%). There were drastic improvements in patients' weight following bariatric surgery. However, there were several complications including nutrient deficiencies. Due to the anatomical changes in the gastrointestinal tract, patients must comply with the dietary and lifestyle changes and follow up with the healthcare professional. A nutrition module will be helpful for patients to prepare for and adapt to the changes after bariatric surgery.

Biological therapy of bariatric surgery complications

In recent years, the number of performed bariatric interventions has increased significantly. Despite the high effectiveness of this method of treatment, the occurrence of complications is not uncommon. The most common complications are stapler line leaks, occurring in 1.5–2.4% of cases; anastomotic leakage after One Anastomosis Gastric Bypass – in 2.2–8% of cases. The problem with all methods is the increased duration of treatment and the need to go without food for significant periods of time, which means starting parenteral nutrition and risking malnutrition. The article demonstrates the effectiveness of biological therapy for complications of bariatric surgery in a series of clinical cases. Clinical cases of 2 patients with anastomotic leakage after One Anastomosis Gastric Bypass are described; also 2 patients with incompetent staple line after laparoscopic Sleeve Gastrectomy. PRP therapy, stromal vascular fraction (SVF) and fibrin glue were used. Platelet-rich plasma is an autologous blood serum containing high concentrations of platelets and growth factors. As a result, after 4 courses of PRP therapy, the patient with the failure of the upper third of the stapler line received an application of twocomponent fibrin glue “Kriofit” with a positive effect. In addition, positive dynamics was observed in the patient with the use of threecomponent therapy of anastomotic leakage. Based on the above facts, it can be concluded, that biological therapy demonstrates great potential value in the treatment of bariatric surgery complications such as stapler line leaks, and anastomotic leakage.

0585 PAP Therapy Impact on Bariatric Surgery Complications: A 30-Day Pre-Operative Evaluation

0585 PAP Therapy Impact on Bariatric Surgery Complications: A 30-Day Pre-Operative Evaluation

Endoscopic closure techniques of bariatric surgery complications: a meta-analysis.

Leaks following bariatric surgery, while rare, are potentially fatal due to risk of peritonitis and sepsis. Anastomotic leaks and gastro-gastric fistulae following Roux-En-Y gastric bypass (RYGB) as well as staple line leaks after sleeve gastrectomy have historically been treated multimodally with surgical drainage, aggressive antibiotic therapy, and more recently, endoscopically. Endoscopic clipping using over-the-scope clips and endoscopic suturing are two of the most common approaches used to achieve full thickness closure. A systematic literature search was performed in PubMed to identify articles on the use of endoscopic clipping or suturing for the treatment of leaks and fistulae following bariatric surgery. Studies focusing on stents, and those that incorporated multiple closure techniques simultaneously, were excluded. Literature review and meta-analysis were performed with the PRISMA guidelines. Five studies with 61 patients that underwent over-the-scope clip (OTSC) closure were included. The pooled proportion of successful closure across the studies was 81.1% (95% CI 67.3 to 91.7). The successful closure rates were homogeneous (I2 = 39%, p = 0.15). Three studies with 92 patients that underwent endoscopic suturing were included. The weighted pooled proportion of successful closure across the studies was shown to be 22.4% (95% CI 14.6 to 31.3). The successful closure rates were homogeneous (I2 = 0%, p = 0.44). Three of the studies, totaling 34 patients, examining OTSC deployment reported data for reintervention rate. The weighted pooled proportion of reintervention across the studies was 35.0% (95% CI 11.7 to 64.7). We noticed statistically significant heterogeneity (I2 = 68%, p = 0.04). One study, with 20 patients examining endoscopic suturing, reported rate of repeat intervention 60%. Observational reports show that patients managed with OTSC were more likely to experience healing of their defect than those managed with endoscopic suturing. Larger controlled studies comparing different closure devices for bariatric leaks should be carried out to better understand the ideal endoscopic approach to these complications.

Intussusception and Gut Dysmotility: A Systematic Review Assessing Unexpected Complications of Bariatric Surgery.

Bariatric surgery, although effective in treating obesity-related comorbidities, rarely results in intussusception, which is a severe complication. This study aimed to enhance clinical practice and establish early diagnosis by elucidating risk factors and management strategies associated with intussusception. We conducted this systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis2020 criteria. We looked through PubMed, PubMed Central, ScienceDirect, ScienceOpen, MyScienceWork, Hyper Articles en Ligne (HAL), Google Scholar, and the Medical Literature Analysis and Retrieval System Online for relevant studies and research. Articles were screened according to inclusion and exclusion criteria, and relevance. We employed pertinent quality appraisal instruments to look for bias. Initially, we discovered 2,833 items. We eliminated redundant and unnecessary publications. After reviewing all the articles, we selected 30 studies based on their titles and abstracts. Out of the 30 studies reviewed, 12 papers were included in this review, with the remaining 18being eliminated due to low quality. Medical practitioners and surgeons have a responsibility to meticulously monitor and provide postoperative surveillance, with a particular emphasis placed on individuals exhibiting symptoms of abdominal pain and vomiting, as there is a clinical imperative to consider the possibility of intussusception. The management approach, whether conservative or surgical, remains contingent upon the clinical context.

Elevated Hb A1C level and revisional bariatric surgery complications

BackgroundElevated Hb A1C is a modifiable risk factor for postoperative complications. However, in bariatric surgery, as published by our group and others, elevated preoperative Hb A1C may not be associated with increased postoperative complications. Previous literature has focused on primary bariatric surgery and has excluded the higher-risk revisional surgery cohort. ObjectiveTo assess the impact of Hb A1C on early postoperative outcomes in patients requiring revisional bariatric surgery. SettingMetabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. MethodsWe undertook a retrospective review of patients undergoing revisional bariatric surgery between 2017 and 2018 from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Two groups were studied, defined by Hb A1C cutoff, ≤8% versus >8% and ≤10% versus >10%. Early postoperative complications were compared at each threshold, with the primary outcome defined as a composite of all complications. Propensity score matching (PSM) was used with one-to-one matching for covariates, and the complication rates before and after PSM were calculated and assessed by Fisher’s exact test and conditional logistic regression, respectively. ResultsA total of 16,234 patients had undergone revisional bariatric surgery. After PSM, elevated Hb A1C was not associated with worse outcomes. No significant difference was seen in the composite outcomes for Hb A1C ≤8% versus Hb A1C >8% (P = .22) or for patients with Hb A1C ≤10% versus Hb A1C >10% (P < .46). There were no differences in individual outcomes such as surgical-site infections, cardiopulmonary complications, or readmissions/reinterventions. ConclusionIn this study of revisional bariatric patients, elevated Hb A1C >8% or >10% was not associated with increased postoperative complications. Prospective studies are needed to investigate this further.

Prevalence of Micronutrient Deficiencies in Preoperative Bariatric Patients in a New Zealand Tertiary Centre.

A potential complication of bariatric surgery is development of nutritional deficiencies. Study aims were to assess prevalence of micronutrient deficiencies in preoperative bariatric patients and to examine for ethnic differences. Retrospective analysis of 573 patients that underwent bariatric surgery at Counties Manukau District Health Board was carried out. Mean preoperative levels of albumin, calcium, phosphate, folate, vitamin B12, vitamin D, magnesium, haemoglobin, haematocrit, mean cell volume, mean cell haemoglobin, ferritin, iron, and transferrin were calculated. Chi square, fisher exact test, and multiple logistic regression was used to assess for differences in prevalence of micronutrient deficiencies across ethnicities. The most common micronutrient deficiency was vitamin D (30.85%). There were statistically significant differences invitamin D deficiency across ethnicities(p < 0.0001). Asians hadthe highest prevalence of vitamin D deficiency (60%), followed by Pacifica (44.57%), and Māori (31.68%). Asians were more likely to have vitamin D deficiency compared to NZ/Other Europeans (OR = 14.93, p < 0.001). Vitamin D deficiency was associated with higher BMI (OR = 1.05, p = 0.008). The second most common deficiency was iron (21.1%). Asians had the highest prevalence of iron deficiency (44%), followed by Māori (27.95%), and Pacifica (19.57%) (p = 0.0064). Compared to NZ/Other Europeans, Asians (OR = 4.26) and Māori (OR = 1.78) were more likely to be iron deficient (p = 0.004). Female gender was associated with iron deficiency(OR = 2.12, p = 0.007). Vitamin D and iron are the most common micronutrient deficiencies among preoperative bariatric patients in this cohort and ethnic differences were seen. There may be a role for preoperative supplementation in these at-risk ethnic groups.

Low Mass Low Beat: The Effect of Bariatric Surgery on Cardiac Rhythm

Obesity is a global health problem, associated with significant morbidity and mortality. It is a multifactorial disorder associated with serious complications including diabetes mellitus, dyslipidemia and Cardiovascular Disease (CVD). Its prevalence has been increasing over the last few decades and has become a modern-day epidemic. The management and the treatment of obesity include lifestyle modifications and increased physical activity. Patients with a BMI of greater than 35 kg/m2 with other comorbidities such as type two diabetes are considered eligible for bariatric surgery. There is a plethora of evidence about the effect of bariatric surgery on medical outcomes including reversal of metabolic disease and reduction of negative cardiovascular outcome. Based on the few reported cases in the medical literature, increased cholinergic tone manifesting as bradycardia and delayed chronotropic response on stress test have been reported in post-bariatric surgery patients with significant weight loss. We reported three cases of patients that underwent bariatric surgery and present with brady-arrythmias. While considering other complications of bariatric surgery, it is important to consider cardiac related sequalae such as bradyarrhythmias like sinus bradycardia, atrioventricular block, sick sinus syndrome due to delayed chronotropic response and irreversible atrioventricular defect could be helpful in clinical decision making. We recommend that an EKG and echocardiogram should be a performed as part as of a routine analysis in patients who had a bariatric surgery.

Prior bariatric surgery is associated with lower mortality and resource utilization following small bowel obstruction

BackgroundSmall bowel obstruction (SBO) is a complication of bariatric surgery. However, outcomes of surgical intervention for SBO among patients with prior bariatric surgery remain ill-defined. We used a nationally representative cohort to characterize the outcomes of the SBO management approach in patients with a prior bariatric operation. MethodsAll adult hospitalizations for SBO were tabulated from the 2018–2020 National Readmissions Database. Patients with a prior history of bariatric surgery comprised the Bariatric cohort (others: Non-Bariatric). Multivariable models were subsequently developed to evaluate the association of prior bariatric surgery with outcomes of interest. ResultsOf an estimated 299,983 hospitalizations for SBO, 15,788 (5.3 %) had a history of prior bariatric surgery. Compared to Non-Bariatric, Bariatric patients were younger (54 [46–62] vs 57 [47–64] years, P < 0.001) and were more frequently privately insured (45.1 vs 39.4 %, P < 0.001). On average, the Bariatric more frequently underwent operative management, relative to Non-Bariatric (44.8 vs 29.7 %, P < 0.001). Following risk adjustment, among those surgically managed, Bariatric demonstrated lower odds of mortality (Adjusted Odds Ratio [AOR] 0.69, 95 % Confidence Interval [CI] 0.55–0.87) compared to Non-Bariatric. Bariatric also demonstrated lower odds of infectious and renal complications. Furthermore, the Bariatric cohort had lower costs, length of stay, and non-home discharge. ConclusionsPatients with prior bariatric surgery demonstrated a lower likelihood of mortality, decreased complications, and reduced resource utilization, relative to others. As the incidence of bariatric surgery continues to rise, future work is needed to minimize the incidence of SBO among these patients, especially in the current era of value-based healthcare.

Surgical complications of bariatric surgery among patients with rheumatic diseases.

Obesity is one the most prevalent diseases all around the world. Some studies have shown a relationship between obesity and the worsening of rheumatic disorders. Higher rates of surgical complications might also be seen among these patients. This retrospective-descriptive study was performed on 25 patients with rheumatic disease referred to Loghman Hakim Hospital (Tehran- Iran) and candidates for bariatric surgery (laparoscopic Roux-en-Y gastric and laparoscopic sleeve gastrectomy) from 2018 to 2020. Duration of hospitalization after surgery and history of post-operation surgical and rheumatic complications were assessed. Patients were followed through 6 months after surgery. The age (Mean±SD) of recruited patients was (38.4 ±10.0) years. The mean body mass index was 45.54 kg/m2 with the minimum and maximum values of 37.5 kg/m2 and 56.5 kg/m2. Among them, the prevalence of rheumatic disorders was rheumatoid arthritis 32%, psoriasis 28%, gout 16%, lupus erythematosus 8%, and other rheumatologic disorders 16%, respectively. One patient had a surgical complication that was a port site infection. One patient had a relapse of gout and other patients had remission and also, their therapeutic drugs were discontinued or reduced. Patients with rheumatic disorders revealed no higher surgical complication rate after bariatric surgery, and bariatric surgery helped disease remission among these patients.

Management of Severe Malnutrition Post-bariatric Surgery Using Artificial Nutrition.

Bariatric surgery (BS) results in major and sustained weight loss and improves comorbidities in patients with obesity but can also lead to malnutrition, especially through severe malabsorption and/or surgical complications. Little is known about the efficacy of artificial nutrition (AN) in this setting. In this case series, we describe data from consecutive severely malnourished patients after BS (resectional and non-resectional), managed by AN at our hospital unit over a 4-year period. Between January 2018 and June 2022, 18 patients (mean ± SD age 42.2 ± 10.4 years, 94% women) required AN following BS complications. At the time of AN initiation, more than half of the patients (53%) had multiple revisional surgeries (up to four). Mean BMI was 49.7 ± 11.3 kg/m2 before BS and 29.6 ± 9.6 kg/m2 when AN was initiated. Most patients (n=16, 90%) received enteral nutrition. AN management resulted in weight regain (+4.7kg ± 8.0, p=0.034), increased serum albumin (+28%, p=0.02), pre-albumin (+88%, p=0.002), and handgrip strength (+38%, p=0.078). No major AN complication nor death was observed. Median total AN duration was 4.5 months [1-12]. During follow-up, the cumulative duration of hospitalization was 33 days [4-88] with a median of 2.5 hospitalizations [1-8] per patient. Malnutrition can occur after any BS procedure, and AN when required in this setting appears safe and effective on nutritional parameters. It is important to recognize the potential risk factors for malnutrition, which include excessive weight loss resulting from surgical complications, eating disorders, multiple revisional BS, and pregnancy.

Endoscopic Management of Surgical Complications of Bariatric Surgery

Endoscopic Management of Surgical Complications of Bariatric Surgery

Postbariatric surgery hypoglycemia: Nutritional, pharmacological and surgical perspectives.

Post-bariatric hypoglycaemia (PBH) is a metabolic complication of bariatric surgery (BS), consisting of low post-prandial glucose levels in patients having undergone bariatric procedures. While BS is currently the most effective and relatively safe treatment for obesity and its complications, the development of PBH can significantly impact patients' quality of life and mental health. The diagnosis of PBH is still challenging, considering the lack of definitive and reliable diagnostic tools, and the fact that this condition is frequently asymptomatic. However, PBH's prevalence is alarming, involving up to 88% of the post-bariatric population, depending on the diagnostic tool, and this may be underestimated. Given the prevalence of obesity soaring, and an increasing number of bariatric procedures being performed, it is crucial that physicians are skilled to diagnose PBH and promptly treat patients suffering from it. While the milestone of managing this condition is nutritional therapy, growing evidence suggests that old and new pharmacological approaches may be adopted as adjunct therapies for managing this complex condition.

Awareness About the Benefits of Post-bariatric Surgery in Diabetic Patients in Makkah Almukarramah, Saudi Arabia.

To measure awareness about the benefits of post-bariatric surgery, which is a shortening of the gut in order to lose weight in diabetic patients in the Makkah region, Saudi Arabia. A cross-sectional survey was conducted among diabetic patients aged 18-65 from February to July 2023. An online questionnaire via Google Forms was distributed and used to assess the participants' awareness of the benefits of post-bariatric surgery for diabetic patients. Overall, 388 participants (56.40% female, 43.60% male) were surveyed. Most participants (91.5%) showed awareness of gastric sleeve surgery, while a significant proportion (85.8%) recognized obesity as a disease. A majority of participants (80.90%) showed awareness of the association between obesity, diabetes, and high blood pressure. However, only 46.10% of participants showed awareness of eligibility criteria associated with bariatric surgery. The majority recognized the effectiveness of bariatric surgery for weight loss but did not consider it the first choice, emphasizing a preference for non-surgical weight loss strategies. Participants demonstrated good knowledge about obesity and its implications for health. They also demonstrated good knowledge about bariatric surgery as an effective weight reduction method but expressed a preference for non-surgical methods, which reflects their awareness of the complications of bariatric surgery. However, the results showed a lack of awareness of postoperative indications and lifestyle changes, thus highlighting the need for comprehensive patient education and counseling.

Eating disorders among bariatric surgery patients: The chicken or the egg?

Postoperative eating behaviors and unhealthy weight control measures are leading causes of bariatric surgery complications. Candidates for bariatric surgery and individuals with eating disorders may share common risk factors, such as a history of dieting, and/or being bullied or teased for their weight. Binge-eating disorder, night eating syndrome, and bulimia nervosa are the most common eating disorders among candidates for bariatric surgery before the operation. Malnutrition, stress, and intense fear of weight gain can lead to the development of an eating disorder after surgery as well. Plugging, grazing, loss of control eating, dumping, and food avoidance are specific disordered behaviors that may present after bariatric surgery. To improve physical and psychological outcomes for individuals under their care, clinicians can screen for these disordered behaviors and distinguish them from a healthy diet and the expected postsurgical course.

Unreported rare but serious complication: Major vascular injuries during bariatric surgery.

The aim of this study was to investigate the incidence, risk factors, clinical presentation, and management of major vascular injuries during bariatric surgery, with a specific focus on the role of different access methods in abdominal cavity entry. A nationwide survey was conducted among bariatric surgeons to assess the prevalence of major vascular injuries. A questionnaire was distributed to 365 surgeons through WhatsApp groups of two national bariatric surgery societies, with 76 surgeons completing the survey. The study population included general surgeons practicing bariatric surgery, and the questionnaire consisted of 12 questions. Among the participants, 16.9% reported experiencing a major vascular injury during bariatric surgery. The majority of injuries (75%) occurred at the trocar entrance, with the remaining cases during the dissection phase. Notably, 66.7% of surgeons used optical trocars for access, while 27.8% employed the Veress needle technique. Early detection varied, with 45% identifying the injury immediately and 30% recognizing it within three minutes. Most injuries (52.4%) were repaired laparoscopically, and only three surgeons sought assistance from cardiovascular surgeons. Vascular injuries are infrequent but potentially serious complications in laparoscopic bariatric surgery. Understand-ing their incidence, timely recognition, and proper management are crucial to minimize adverse effects. The findings of this study shed light on the patterns of vascular injuries and the potential role of specific access methods, providing valuable insights for enhancing patient safety in bariatric surgery.

A nomogram to predict postoperative nausea and vomiting in the ward following laparoscopic bariatric surgery.

Postoperative nausea and vomiting (PONV) is a common and distressing complication of laparoscopic bariatric surgery (LBS). However, there is a lack of effective integrated prediction models for preventing and treating PONV in patients after LBS. Based on a randomized controlled trial conducted between November 1, 2021, and May 13, 2022, we included 334 participants who underwent LBS according to the inclusion criteria. The database was divided randomly into training and validation cohorts in a ratio of 7:3. Least absolute shrinkage and selection operator plus multivariable logistic regression were used to identify independent predictors and construct a nomogram. The performance of the nomogram was assessed and validated by the area under the receiver operating characteristic curve (AUC), the concordance index (C-index), calibration plots, and a decision curve analysis (DCA). We also explored specific risk factors for PONV in patients with diabetes. The subjects were divided randomly into training (n = 234) and validation (n = 100) cohorts. Age, history of diabetes, type of surgery, and sugammadex use were incorporated to construct a nomogram prediction model. In the training cohort, the AUC and the optimism-corrected C-index were 0.850 [95% confidence interval (CI) 0.801-0.899] and 0.848, while in the validation cohort they were 0.847 (95%CI 0.768-0.925) and 0.844, respectively. The calibration plots showed good agreement between the predicted and actual observations. The DCA results demonstrated that the nomogram was clinically useful. The type of surgery, sugammadex use, and insulin level at 120min were predictors of PONV in patients with diabetes with an AUC of 0.802 (95%CI 0.705-0.898). We developed and validated a prediction model for PONV in patients after LBS. A risk factor analysis of PONV in patients with diabetes provides clinicians with a more precise prophylactic protocol.

THU276 The Use of Continuous Glucose Monitors for Management of Postbariatric Hypoglycemia

Abstract Disclosure: S. Jani: None. S. Bao: None. Postprandial hypoglycemia is a known complication of bariatric surgery. Mixed meal tolerance test performed in these patients often revealed hypoglycemia 1-3 hours after meals. Recent clinical studies using continuous glucose monitors (CGM) have shown the incidence of postbariatric hypoglycemia is much higher than previously identified. In addition to diet modification and medication treatment, CGM has become a more popular and useful tool in managing severe cases. We present a case of using CGM to manage postbariatric hypoglycemia. A 47 year old female with prior history of class 3 obesity treated with sleeve gastrectomy presented with hypoglycemia 2.5 years after her bariatric surgery. She complained of headache, anxiety, dizziness, and fatigue during a routine clinic visit, two hours after consuming a carbohydrate rich meal with simple sugars. Blood glucose was obtained and revealed severe hypoglycemia (glucose 38 mg/dL). This prompted an urgent referral to endocrinology. Review of glucose trends revealed multiple instances of postprandial hypoglycemia. Further labs suggested a low likelihood for insulinoma with no fasting hypoglycemia and HA1C normal at 5.3%. Postprandial hyperinsulinemic hypoglycemia was suspected clinically. Dietary modification with multiple small meals consisting of high protein, fiber and complex carbohydrates was recommended. Additionally, she was started on Libre 2 CGM for monitoring and prevention of severe hypoglycemia. Review of her CGM data during follow up visit demonstrated very low incidence of hypoglycemia and absence of severe hypoglycemia. Over time with continued use of her CGM and low incidence of hypoglycemia, she did not require medical therapy. Postprandial hypoglycemia after bariatric surgery can be severe and lead to disabling neuroglycopenic symptoms. With increased utilization of bariatric surgery, these postoperative complications will likely become more prevalent. In a Swedish nationwide study, the prevalence of postbariatric hypoglycemia was close to 0.2% in a cohort of 5040 patients. However, a more recent prospective study with a two-year observation of 333 patients after bariatric surgery using 2-hour glucose tolerance test revealed much higher prevalence of severe postprandial hypoglycemia (25.6%). Hypoglycemia was highest after gastric bypass surgery (32.6%), followed by sleeve gastrectomy (22.6%). Currently, there is no official guideline on utilization of CGM in management of hypoglycemia in nondiabetic patients. This case highlights the role of CGM in managing postbariatric hypoglycemia. CGM provides continuous glucose data, trends and alerts that can be a critical tool for patients to monitor, anticipate and prevent hypoglycemic events. Additionally, the real time data provided by CGM’s can help clinicians identify high risk patients who may benefit from the addition of medications to treat hypoglycemia. Presentation: Thursday, June 15, 2023

FRI666 Postbariatric Hypoglycemia: The Brody School Of Medicine Institutional Experience

Abstract Disclosure: Z. Jiang: None. M.R. Azad: None. M. Seagrove-Guffey: None. M. Javaid: None. A.J. Drake: None. M.S. Dar: None. Background and objectives: Post-bariatric hypoglycemia (PBH) is a complication of bariatric surgery and occurs most often after meals but can be nocturnal. PBH tends to occur most often after Roux-en-Y gastric bypass (RYGB). Hypoglycemia severity ranges from mild symptoms to severe lows that require assistance and can be life threatening. The management of PBH is challenging due to its variable presentation and incompletely understood pathophysiology. Medical nutrition therapy is tried initially followed by medical therapy if patients do not respond. Reversal of RYGB is reserved for the most refractory cases. Here we present our institutional experience treating PBH patients (pts) between 2007-2014. Methods: This is a retrospective cohort study of PBH pts seen between 2007-2014 at our institution. Thirty RYGB pts with PBH were included in the study. PBH was confirmed when symptoms of sweating, shakiness, tachycardia, and confusion that were correlated with a fingerstick blood sugars (FSBS) &amp;lt;70 mg/dl which improved after FSBS &amp;gt;70 mg/dl. Mixed meal testing was not done. Pts were referred for medical nutrition therapy. If there was no improvement in hypoglycemia frequency/severity in 3-6 months, Acarbose or Creon were tried at the discretion of the physician with Diazoxide reserved for patients who were refractory to these medicines. Results: Most of the pts were Caucasian females (26/30) without diabetes (25/30) and mean age was 54 +/- 9 years. BMI decreased after RYGB (47.8 +/- 9.2 to 26.4 +/- 4.9) and the weight loss nadir occurred at 26 months for most patients. The average time to first episode of hypoglycemia for all PBH pts was 28 months but only 11 months for PBH pts with pre-diabetes. About 47% of PBH pts (14/30) reported some improvement in the severity and frequency of hypoglycemia after either dietary interventions (8/30) or pharmacological interventions. With regards to pharmacological interventions, Acarbose (3/10 pts), Creon (3/8) and Diazoxide (1/4) all led to some improvement in hypoglycemia frequency and severity. We found that 3 pts with PBH had died. We had access to charts of 2/3 pts and reviewed them to determine cause of death. Both pts had severe PBH with hypoglycemia and loss of consciousness. Pt #1 had a history of atrial fibrillation and developed PBH 8 years after RYGB. He was referred to medical nutrition therapy and lost follow up. Pt # 2 experienced PBH 1 year post-RYGB, treated with Acarbose which did not help. He was then tried on Creon with improvement in the frequency and severity of hypoglycemia and was later lost follow up. Conclusions: PBH is a challenging complication of RYGB and appears to occur more often than previously reported. Medical nutrition and pharmacologic therapy showed modest improvement in PBH severity and frequency but more rigorous controlled trials are needed. PBH may increase the mortality but more research is needed. Presentation: Friday, June 16, 2023

The Impact of Drain Placement on Postoperative Complications in Bariatric Surgery: A Systematic Review and Meta-Analysis.

Obesity in individuals can have consequences ranging from metabolically healthy obesity to serious morbidities and reduce the quality and duration of life. A meta-analysis was conducted to assess the role of abdominal drainage on postoperative complications after bariatric surgery. PubMed, Embase, and the Cochrane Library were systematically searched for eligible studies. The results revealed that abdominal drainage was associated with surgical complications, with a pooled odds ratio (OR) of 1.70 (P < .001), but not associated with wound infection (OR: 1.04; P = .762). Associations with surgical complications were mainly detected from retrospective cohort studies. The use of abdominal drainage showed associations with death (OR: 1.68; P < .001) and reoperation (OR: 1.49; P < .001). These findings revealed that abdominal drainage during bariatric surgery was associated with surgical complications, death, and reoperation. These results should be taken with caution since randomized controlled trials and retrospective studies were analyzed together.