Bariatric Surgical Emergencies

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.