Postoperative Complications Of Bariatric Surgery Research Articles

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.

The impact of procedure type on 30-day readmissions following metabolic and bariatric surgery: postoperative complications of bariatric surgery.

Hospital readmission (HR) rates following metabolic/bariatric surgery (MBS) are used as a surrogate for quality outcomes and are increasingly tied to reimbursement rates. There are limited data concerning predictors of HR rates with regard to type of bariatric procedure. This study is a retrospective review of prospectively collected data from patients who underwent MBS from January 2014 to December 2019 at Brigham and Women's Hospital in Boston, Massachusetts. The causes of all HRs and reoperations within 30days of the original discharge were analyzed. Statistical significance was determined using Chi Squared test and T test. 2815 patients underwent MBS. 2373 patients (84.3%) had primary procedures, while 442 patients (15.7%) had secondary or revisional procedures. The overall 30-day readmission rate was 5.7%, with no significant difference for patients who underwent primary vs. secondary MBS. Among primary procedures, the readmission rate was higher for Roux-en-Y Gastric Bypass (RYGB) than laparoscopic sleeve gastrectomy (SG) (10.32% vs. 4.77%). Readmissions were most often due to nontechnical causes. The overall reoperation rate was 1.14% and was higher for patients undergoing secondary vs. primary procedures (2.94% vs 0.80%). Readmission rate was similar to that in existing literature. Revisional/secondary surgery did not lead to increased readmissions, although was associated with a higher reoperation rate. Most HRs were due to nontechnical causes. Optimization of postoperative care, such as fluid status, may reduce the incidence of postoperative complications.

The influence of summer closure on serious postoperative complications in bariatric surgery

IntroductionBariatric surgery is an effective method of treating obesity, with gastric bypass and sleeve gastrectomy being the most common techniques used worldwide. Despite the technical challenges in these methods, little is known about the effects of summer closure on the incidence of serious postoperative complications in surgeries performed shortly after summer vacation. This has therefore been studied in our large cohort.Materials and methodsA retrospective cohort study based on data from the Scandinavian Obesity Surgery Registry was conducted. Patients who underwent a primary gastric bypass or sleeve gastrectomy operation between 2010 and 2019 were included. The rate of serious complications within 30 days after surgery for patients who underwent surgery the first month after summer closure was compared to those who underwent surgery during the rest of the year using the χ2 test and adjusted logistic regression.ResultsThe study included 42,404 patients, 36,094 of whom underwent gastric bypass and 6310 of whom received sleeve gastrectomy. Summer closure was associated with an increased risk for serious postoperative complications in gastric bypass surgery (adjusted odds ratio (adj-OR) = 1.17; 95% confidence interval (CI): 1.01–1.36). No statistically significant association was seen for sleeve gastrectomy (adj-OR = 1.17; 95% CI: 0.72–1.91), nor in overall complication rate.ConclusionsSummer closure increases the risk of serious postoperative complications in gastric bypass surgery. No statistically significant association was found for sleeve gastrectomy surgery.

Modern principles of prevention of early postoperative complications in bariatric surgery (review of literature)

The article presents the problem of the development of complications of bariatric surgery in the early postoperative period. After the start of the use of endovideosurgical technologies in bariatric surgery, the incidence of general surgical complications in the early postoperative period dropped sharply to 2-6 %. Nevertheless, serious complications still arise, the frequency and type of which largely depends on the patient's comorbidity and the complexity of the operation. The most formidable and difficult complication in treatment is the failure of the sutures of the stomach stump (stapler line), which is more often characteristic of longitudinal resection of the stomach and occurs in 1.5-2.4 % of cases. Deep vein thrombosis is another serious complication in bariatric surgery - the incidence ranges from 2.4 to 4.5 %. Bleeding is no less serious complication of obesity surgery. The frequency of repeated interventions associated with bleeding in the early postoperative period is 11 %. Moreover, in 85 % of cases, conservative methods of stopping bleeding are successful. Considering that the permissible operational lethality of bariatric operations should not exceed 0.1 %, the issues of developing a unified concept of prevention methods to reduce the incidence of complications in patients with morbid obesity remain relevant.

The Importance of Health Literacy in Prevention of Postoperative Complications in Bariatric Surgery

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What is the Role of Image-Guided Endovascular Surgery in Postbariatric Surgery Bleeding Complications?

Background: Obesity treatment requires surgical procedures included in bariatric surgery. Bleeding complications are reported in 1%-4%. Image-guided surgery (IGS) includes minimally invasive procedures that have the advantage of less aggression to the patient, fewer complications, and a quick recovery. Endovascular therapy by interventional radiology (IR) is a minimally invasive image-guided procedure widely used in central, peripheral, and splanchnic vascular pathology. Treatment of postoperative bleeding in bariatric surgery can be aided by image-guided endovascular procedures. Objectives: The aim of this study is to carry out an update on the application of IR in bariatric surgery bleeding complications. Bleeding Complications: General rate of postoperative complications in bariatric surgery is 0%-10%. Postoperative bleeding (1%-4%) can be gastrointestinal (endoscopic treatment) or intra-abdominal (surgical treatment/relaparoscopy). In the case of arterial vascular lesions that cannot be resolved either endoscopically or surgically, the option of endovascular treatment with IR should be considered. Conclusions: Endovascular approach through IR and IGS in bleeding complications after bariatric surgery is presented as a valid minimally invasive therapy option in this group of patients.

Deep Learning Neural Networks to Predict Serious Complications After Bariatric Surgery: Analysis of Scandinavian Obesity Surgery Registry Data.

BackgroundObesity is one of today’s most visible public health problems worldwide. Although modern bariatric surgery is ostensibly considered safe, serious complications and mortality still occur in some patients.ObjectiveThis study aimed to explore whether serious postoperative complications of bariatric surgery recorded in a national quality registry can be predicted preoperatively using deep learning methods.MethodsPatients who were registered in the Scandinavian Obesity Surgery Registry (SOReg) between 2010 and 2015 were included in this study. The patients who underwent a bariatric procedure between 2010 and 2014 were used as training data, and those who underwent a bariatric procedure in 2015 were used as test data. Postoperative complications were graded according to the Clavien-Dindo classification, and complications requiring intervention under general anesthesia or resulting in organ failure or death were considered serious. Three supervised deep learning neural networks were applied and compared in our study: multilayer perceptron (MLP), convolutional neural network (CNN), and recurrent neural network (RNN). The synthetic minority oversampling technique (SMOTE) was used to artificially augment the patients with serious complications. The performances of the neural networks were evaluated using accuracy, sensitivity, specificity, Matthews correlation coefficient, and area under the receiver operating characteristic curve.ResultsIn total, 37,811 and 6250 patients were used as the training data and test data, with incidence rates of serious complication of 3.2% (1220/37,811) and 3.0% (188/6250), respectively. When trained using the SMOTE data, the MLP appeared to have a desirable performance, with an area under curve (AUC) of 0.84 (95% CI 0.83-0.85). However, its performance was low for the test data, with an AUC of 0.54 (95% CI 0.53-0.55). The performance of CNN was similar to that of MLP. It generated AUCs of 0.79 (95% CI 0.78-0.80) and 0.57 (95% CI 0.59-0.61) for the SMOTE data and test data, respectively. Compared with the MLP and CNN, the RNN showed worse performance, with AUCs of 0.65 (95% CI 0.64-0.66) and 0.55 (95% CI 0.53-0.57) for the SMOTE data and test data, respectively.ConclusionsMLP and CNN showed improved, but limited, ability for predicting the postoperative serious complications after bariatric surgery in the Scandinavian Obesity Surgery Registry data. However, the overfitting issue is still apparent and needs to be overcome by incorporating intra- and perioperative information.

Safety and effectiveness of laparoscopic Y-en-Roux gastric bypass surgery in obese elderly patients.

Purpose To analyze, in aged obese patients, the weight loss, comorbidity control, and safety postoperative complications of bariatric surgery by Roux-en-Y gastric bypass technique.Methods Twenty-seven patients who underwent laparoscopic weight-reducing gastroplasty with Roux-en-Y gastric bypass to treat obesity were included. All patients were ≥ 60 years old at the time of surgery. The Wilcoxon test was used for statistical analysis, and a p-value ≤0.05it was considered significant.Results Ten (90.9%) patients with dyslipidemia were cured (p < 0.001). Nine (81.8%) patients with type 2 diabetes mellitus had total improvement and 2 (18.2%) had partial improvement (p = 0.003). In 23 patients with systemic arterial hypertension, 9 (39.1%) achieved total improvement and 14 (60.9%) partial improvement (p = 0.140). Five (71.4%) patients with obstructive sleep apnea syndrome were cured (p = <0.001). For other comorbidities, no partial improvement or cure was shown.Conclusions Roux-en-Y gastric bypass surgery in obese elderly patients can be performed safely and with low morbidity and mortality rates. The benefits of weight loss and reduced comorbidities are promising and like those of the younger population.

A306 CRP levels and post-operative complications in bariatric surgery: a single institution experience

A306 CRP levels and post-operative complications in bariatric surgery: a single institution experience

Metabolic Syndrome and Short-Term Postoperative Complications in Bariatric Surgery: The Whole Is Not Always Greater Than the Sum of Its Parts

Metabolic Syndrome and Short-Term Postoperative Complications in Bariatric Surgery: The Whole Is Not Always Greater Than the Sum of Its Parts

Influence of Helicobacter pylori infection on gastrointestinal symptoms and complications in bariatric surgery patients: a review and meta-analysis

BackgroundNumerous papers have discussed the importance of preoperative detection and eradication of Helicobacter pylori (HP) in bariatric patients. ObjectivesThis systematic review specifically focuses on the influence of HP infection on clinical symptoms, complications, and abnormal endoscopic findings in postbariatric patients. MethodsA systematic search on the influence of HP infection on postoperative complications in bariatric surgery was conducted. The methodologic quality of the included studies was rated using the Newcastle-Ottawa rating scale. The agreement between the reviewers was assessed with Cohen's kappa. The included studies were assessed into 2 groups, studies with and without eradication therapy preoperatively. ResultsA total of 21 studies were included with a methodologic quality ranging from poor to good. The agreement between the reviewers, assessed with the Cohen's kappa, was .70. Overall, tendency in the included studies was that HP infection was associated with an increased risk for developing marginal ulcers and postoperative complications. A meta-analysis on the incidence of marginal ulcers and overall postoperative complications was conducted and showed, respectively, an odds ratio of .508 (.031–8.346) and 2.863 (.262–31.268). ConclusionsHP is frequently found in patients before and after bariatric and metabolic surgery. We assessed whether, according to the current literature, HP increases the risk for developing postoperative complications after surgery. This meta-analysis shows that a methodologically good study should be performed to clarify the role of HP in bariatric patients and the question of whether HP should be eradicated before surgery.

Endoscopic Management of Bariatric Surgery Complications.

Obesity is a global epidemic that has significant impact on morbidity, mortality, and rising health care costs. In morbidly obese patients with body mass index >40 kg/m2, bariatric surgery is a grade A recommendation and is associated with up to 40% reduction in premature death. Increasingly, endoscopy is seen as a safer and more cost-effective approach to the management of weight loss surgery complications including gastrointestinal bleeding, development of anastomotic ulcers, staple-line leaks and fistulas, strictures, weight regain, bezoars, choledocholithiasis, and gastric band erosion and slippage. Many endoscopic interventions currently rely on a combination of specialized equipment, such as stents, suture systems, clips, and balloon dilators to successfully treat these issues. This article will present common postoperative complications in bariatric surgery, discuss the latest evidence for their endoscopic management, and offer future directions in the endoluminal therapy of obese patients.

A5208Diabetes mellitus after roux-en-y gastric bypass : what happens after weight regain?

studies and cases with average follow-up time of at least one year (n1⁄486), pooled mean SD of prevs. post-operative HbA1C was 8.49 1.31 vs. 7.89 1.07 %, respectively (P o0.001, for both analyses using estimated covariance and conservative approach). Improvement in lipid profile and blood pressure was shown in 4 case series. In addition to common postoperative complications of bariatric surgery, profound glycemic changes (diabetic ketoacidosis, and episode of severe hypoglycemia) and GI dysmotility symptoms (prolonged ileus, intractable nausea and vomiting, and acute gastric remnant dilation) have been reported in this population following surgery. No mortality was reported. Conclusion: The findings of the first systematic review and metaanalysis of this kind indicate that bariatric surgery leads to a remarkable weight loss in severely obese patients with T1D and results in significant improvement in insulin requirements and glycemic status. The favorable metabolic effects of bariatric surgery may facilitate medical management of T1D in the setting of severe obesity. However, results are limited to short follow-up time and are based on a small number of studies and individuals. Short term results of bariatric surgery in patients with T1D are promising but larger and longer studies are necessary.

The role of upper gastrointestinal endoscopy in treating postoperative complications in bariatric surgery

There are an estimated 500 million obese individuals worldwide. Currently, bariatric surgery has been shown to result in clinically significant weight loss. With increasing demand for bariatric surgery, endoscopic techniques used intra and postoperatively continue to evolve. Endoscopic evaluation of anastomotic integrity following RYGB allows for early detection of anastomotic leaks. Furthermore, endoscopy is a valuable tool to diagnose and treat RYGB postoperative surgical complications such as anastomotic leakage, hemorrhage and stricture formation. Early evidence suggests that endoscopic management of upper gastrointestinal hemorrhage following RYGB is effective. In addition, endoscopic balloon dilatation is able to effectively treat obstruction in the setting of gastrojejunal anastomotic strictures. With successful endoscopic management of these complications, bariatric patients may avoid more invasive surgical procedures.

Management of late postoperative complications of bariatric surgery (Br J Surg 2011; 98: 1345–1355) and Cost–utility of bariatric surgery for morbid obesity in Finland (Br J Surg 2011; 98: 1422–1429)

Management of late postoperative complications of bariatric surgery (<i>Br J Surg</i> 2011; 98: 1345–1355) and Cost–utility of bariatric surgery for morbid obesity in Finland (<i>Br J Surg</i> 2011; 98: 1422–1429)

Management of late postoperative complications of bariatric surgery

The prevalence of obesity is increasing worldwide and the past decade has witnessed an exponential rise in the number of bariatric operations performed. As a consequence, an increasing number of patients are presenting to non-specialist units with complications following bariatric procedures. This article outlines the management of the most common late postoperative complications that are likely to present to the general surgeon. A search was conducted for late postoperative complications after bariatric surgery using PubMed, Embase, OVID and Google search engines, and combinations of the terms bariatric surgery, gastric bypass, gastric banding or sleeve gastrectomy, and late or delayed complications. Only studies with follow-up longer than 6 months were included. The most common long-term complications after gastric banding include band slippage and erosion. Deflation or removal of the band is often required. Internal hernia, adhesions and anastomotic stenosis are common causes of intestinal obstruction after gastric bypass surgery. Hepatobiliary complications pose a particular challenge because of the altered anatomy. Functional disorders such as reflux and dumping, and nutritional deficiencies are common and should be differentiated from conditions that require urgent investigations and timely surgical intervention. The immediate management of bariatric patients presenting with complications outside the immediate postoperative period requires adherence to basic surgical principles. Accurate diagnosis often relies on high-quality contrast and cross-sectional imaging, and effective surgical intervention necessitates a broad understanding of the altered anatomy, advanced surgical skills and liaison with specialists in the field when necessary.

Management of late postoperative complications of bariatric surgery (Br J Surg 2011; 98: 1345–1355) and Cost–utility of bariatric surgery for morbid obesity in Finland (Br J Surg 2011; 98: 1422–1429)

Management of late postoperative complications of bariatric surgery (<i>Br J Surg</i> 2011; <b>98</b>: 1345–1355) and Cost–utility of bariatric surgery for morbid obesity in Finland (<i>Br J Surg</i> 2011; <b>98</b>: 1422–1429)

S11

One of the most common post-operative complications of bariatric surgery is venous thromboembolism, manifested as deep vein thrombosis and pulmonary embolism. It is accepted that the pathogenesis of venous thromboembolism involves a genetic component. Factor V mutation is carried by 5% and the Factor II gene is carried by about 2% of the Caucasian population. In the heterozygous form each confers an estimated 5-10 and 2-3 fold risk of venous thromboembolism, respectively. The objective of the study was to determine the incidence of patients undergoing bariatric surgery with genetic mutations and the subsequent impact of prophylactic IVC filter placement.