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Bariatric Surgery
TOP 10 TAKEAWAY MESSAGES:
Bariatric Surgery
1. The two most common bariatric surgical procedures are Roux-
en-Y (RNY) gastric bypass and vertical sleeve gastrectomy (often
performed laparoscopically), which provide clinically meaningful
improvement in metabolic diseases such as type 2 diabetes
mellitus.
2. 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.
3. 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 computerized
tomography (CT) or upper GI study (not barium); treatment is
immediate surgical exploration.
4. Chronic complications of gastric bypass include gastro-gastric
fistula, resulting in an increased capacity to ingest food and
suboptimal weight loss or weight regain.
5. Dumping syndrome is a complication of gastric bypass resulting
in facial flushing, lightheadedness, reactive hypoglycemia,
and postprandial diarrhea in response to a high glycemic load
ingestion.
6. Internal hernia can occur with gastric bypass, with intermittent
postprandial pain and emesis.
7. Sleeve gastrectomy involves removing a portion of the stomach,
leaving less stomach and altering gastrointestinal hormones.
8. Acute complications of sleeve gastrectomy include
gastrointestinal obstruction and staple line leaks.
9. Chronic complications of sleeve gastrectomy include sleeve
dilation, gastroesophageal reflux disease, and luminal stenosis/
strictures.
10. Acute complications that can accompany most any abdominal
surgery include infection, dehydration, cardiac dysrhythmias,
atelectasis and pneumonia, deep vein thrombosis, and
pulmonary emboli.
