18
Bariatric Surgery
➤ Dumping syndrome (RNY)
• Unique complication of RNY (due to bypass of the pyloric
emptying mechanism), which is common in the f irst 18 months
postoperatively.
• Occurs in approximately 70–85 percent of patients with RNY.
• Symptoms: Facial flushing, lightheadedness, fatigue, reactive
hypoglycemia, and postprandial diarrhea.
• Treatment: Often includes avoidance of foods with high glycemic
index/load, avoidance of drinking fluid with meals.
• Acarbose may help alleviate symptoms of dumping syndrome.
➤ Metabolic bone disease (RNY, BPD/DS)
• Secondary hyperparathyroidism and osteopenia resulting from
calcium deficiency.
➤ Gout
• Rapid weight loss may increase the risk of gout exacerbation.
➤ Gallbladder or gallstone disease
• Right upper quadrant or epigastric postprandial or nocturnal pain
(classically radiating to back or right shoulder).
• Diagnostic testing includes labs (if elevated white blood cell count,
alkaline phosphatase, bilirubin, liver transaminases, or amylase lipase
send to Emergency Room for urgent surgical consult).
• Imaging: Abdominal ultrasound (abdominal CT if abdominal wall
thickness impairs ultrasound). Consider hepatobiliary iminodiacetic
acid (HIDA) scan if ultrasound is negative.
➤ Marginal ulcer (at an anastomotic site-most common with RNY)
• Abdominal pain +/– vomiting.
• Best to stop NSAIDS, steroids, nicotine, caffeine, alcohol, and/or illicit
drugs to heal.
• Proton pump inhibitor 3 times/day plus Carafate 4 times/day;
optimize protein intake. Surgery for failed refractory ulcer.
• Diagnose with upper endoscopy.
➤ Kidney stones (RNY, BPD/DS)
• Hyperoxaluria may lead to oxalate kidney stone.
➤ Mental health
• Risk of addiction transference
• Increased risk of suicide
