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Bariatric Surgery
➤ Leak or perforation (RNY, sleeve gastrectomy, BPD/DS)
• Can lead to acute peritonitis.
• Technical failure within the f irst 72 hours (with ischemia can occur
up to 14 days post-op).
• Can also occur at any time due to ulcer perforation (avoid
nonsteroidal anti-inflammatory drugs [NSAIDS], steroids, nicotine,
caffeine, alcohol).
• Often with acute and severe abdominal pain (may NOT have
peritonitis symptoms if on steroids).
• Fever, tachycardia, abdominal or back pain, and leukocytosis.
• Urgent surgical exploration may be required but can sometimes
be managed with endoscopic stent and drain (in selected cases)
• Imaging not always diagnostic but when performed, water soluble
contrast preferred (abdominal CT or upper GI).
• Immediate surgical consultation is critical for suspected leak or
perforation EVEN if imaging is negative.
Late (>30 Days)
➤ Gastro-gastric fistula (RNY)
• Results in increased capacity to ingest food and/or increased passing
of food into the gastric remnant (where it is more completely
digested and absorbed).
• Possible contributing factor to suboptimal weight loss/weight regain
and recurrence of metabolic disease.
• A non-healing ulcer might raise concern for a gastro-gastric fistula.
➤ Band erosion through gastric wall into the lumen (LAGB)
• Suspect if band is full but patient perceives no restriction or
obstructive symptoms with empty or minimally filled band.
• Can also present as infection with pain, fevers, leukocytosis.
• Pain/infection may or may not be present.
• Diagnose with esophagogastroduodenoscopy (EGD). Surgical
consult for removal is required for eroded band.
➤ Incisional hernias (more common with open procedures)
• Pain at one of the incisional sites.
• Maybe be palpable defect but due to body habitus this may be
difficult to ascertain on exam. CT or US is needed to confirm.
• Repair usually postponed until significant weight loss unless signs of
bowel incarceration/strangulation (bowel obstruction).
