Complications of bariatric surgery: the acute care surgeon’s experience

• Bariatric surgical complications commonly present to acute care services.
• Most common presentations are internal hernias and bowel obstructions.
• Most cases are manageable laparoscopically.

BackgroundComplications of bariatric surgeries are common, can occur throughout the patient’s lifetime, and can be life-threatening. We examined bariatric surgical complications presenting to our acute care surgery service.MethodsRecords were reviewed from January 2007 to June 2013 for patients presenting with a complication after bariatric surgery.ResultsLaparoscopic Roux-en-Y gastric bypass was the most common index operation (n = 20), followed by open Roux-en-Y gastric bypass (n = 6), laparoscopic gastric band (n = 4), and vertical banded gastroplasty (n = 3). Diagnoses included internal hernia (n = 10), small bowel obstruction (n = 5), lap band restriction (n = 4), biliary disease (n = 3), upper GI bleeding or ulcer (n = 3), ischemic bowel (n = 2), marginal ulcer (n = 2), gastric outlet obstruction (n = 2), perforated ulcer (n = 2), intussusception (n = 1), and incarcerated ventral hernia (n = 1). Operations were required in 91% of the patients. Laparoscopic outcomes were similar to open; however, open cases were more emergent (23.5% vs 69.2%) and had longer hospital length of stay (4.8 ± 3.5 vs 11.0 ± 10.3 days, P < .05). All patients survived.ConclusionsThe acute care surgeon will encounter complications of bariatric surgery. Internal hernias or obstructive etiologies are the most common presentations and often require emergent or urgent surgery.