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Bariatric Procedures
➤ The two most common bariatric procedures are Roux-en-Y
gastric bypass and vertical sleeve gastrectomy (often performed
laparoscopically), which provide clinically meaningful improvement
in metabolic diseases such as type 2 diabetes mellitus.
➤ Gastric bypass involves dividing the stomach into a small proximal
gastric pouch (leaving a large "bypassed" gastric remnant in situ)
attached to a "roux" limb of small bowel jejunum, bypassing the
larger gastric remnant, all of the duodenum, and a portion of the
proximal small intestine.
• Acute complications of gastric bypass include leaks or perforations
potentially leading to peritonitis with severe abdominal pain,
fever, tachycardia, and leukocytosis. Imaging may include soluble
contrast for abdominal CT or upper GI study (not barium).
Treatment is immediate surgical exploration.
• Chronic complications of gastric bypass include:
▶ Gastro-gastric f istula, resulting in an increased capacity to ingest
food and suboptimal weight loss or weight regain.
▶ Dumping syndrome, resulting in facial flushing,
lightheadedness, reactive hypoglycemia, and postprandial
diarrhea.
▶ Internal hernia can occur with gastric bypass, with intermittent
postprandial pain and emesis.
➤ Sleeve gastrectomy involves removing a portion of the stomach,
leaving less stomach area and altering gastrointestinal hormones.
• Acute complications of sleeve gastrectomy include:
Gastrointestinal obstruction and staple line leaks.
• Chronic complications of sleeve gastrectomy include: sleeve
dilation, gastrointestinal reflux disease and luminal stenosis/
strictures.
➤ Acute complications that can accompany abdominal surgery
include:
• Infection, dehydration, cardiac dysrhythmias, atelectasis and
pneumonia, deep vein thrombosis, and pulmonary emboli.
