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Bariatric Surgical Emergencies

9/13/2017

1 Comment

 
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One-third of Americans self report as obese, and bariatric surgery has become a leading treatment option. Approximately 200,000 procedures are performed annually, most commonly gastric sleeves. 

Common Procedures

Roux en Y Gastric Bypass: Classically the most well known bariatric surgery, where the proximal stomach is attached to the distal small bowel, and the stomach is stapled to create a small functional stomach. The stomach may be attached from the anterior or posterior aspect, leading to some individual variability. ​
Laparoscopic Gastric Banding: A band is placed around the superior stomach by dragging behind the posterior aspect and then secured. 

Sleeve Gastrectomy: The stomach is stapled to removal a large portion of the stomach.

Surgical Complications

  • Anastamotic Leak: Most common early surgical complication, occurring in approximately 6% of cases. May present with minimal abdominal pain, asymptomatic tachycardia, or fever. Should be evaluated with a CT scan vs gastrografin imaging. 
  • Dumping Syndrome: Nausea, vomiting, tachycardia due to rapid transit from the functional stomach to the jejunum. Treated with dietary changes, especially decreasing carbohydrate load. 
  • Pulmonary Embolism: Most common obesity-related complication.
  • Internal Hernia: Can occur in multiple locations, typically either at the transverse mesocolon, Roux limb, or at the jejunostomy. Typically presents later as patients begin to lose weight, and requires a high-index of suspicion and is difficult to find on CT scan. 
  • GI Bleeding: Bariatric patients are technically difficult to endoscopy and may require laparoscopy due to the inability to access the duodenum. 
  • Jejunostomy Stenosis & Obstruction: Dilatation of the biliopancreatic limb and gastric remnant due to scaring or bleeding. 
  • Nutritional Deficiency: Patients are at high-risk for B vitamin deficiencies and anemia. 
  • Band Complications: Most common complication is the 'slipped band' where the band or stomach moves, heading to distal stomach becoming lodged in the band. Bands should lay in a 45 degree pitch towards the left shoulder when measured from the vertebra vertically, referred to as the phi angle.  
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1 Comment
Perumbavoor Surgicals Pvt Ltd. link
8/1/2022 10:47:52 pm

Thanks for the detailed explanation and video. It is a very useful piece of content. I really appreciate your efforts in creating great content like this.

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  • Clinical
    • Discharge Macros
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map