Problems after Bariatric Surgery
OVERVIEW
Operation types
- gastric banding
- gastric bypass
- sleeve gastrectomy
Key points
- peritonism may not be apparent in obese patients
- do not insert a nasogastric tube
- basic surgical principles still apply
- thiamine deficiency can occur following a few days of prolonged vomiting in gastric bypass patients, replace early
PROBLEM-BASED APPROACH
Total dysphagia in a band patient
- suspect acute band slippage
- gastric ischemia may occur in even an apparently well patient and require emergency surgery
- urgent bariatric surgery referral
GI bleed
- suspect anastomotic bleed, marginal ulcer
- may not be accessible by endoscopy, may require surgery
- urgent bariatric surgery referral
Intestinal obstruction
- anastomotic stricture, internal hernia or port site hernia
- urgent bariatric surgery referral
Chest pain, tachycardia and/or breathlessness
- suspect MI, PE, gastric pouch problems, anastomotic leak
- work up DDX as appropriate
- CT may be impossible or misleading
- early discussion with surgical team
Abdominal pain
- suspect subacute obstruction from intenstinal hernia, anastomotic leak
- work up DDX as appropriate
- CT may be impossible or misleading
- early discussion with surgical team
Reflux symptoms, no dysphagia with fluid intake
- suspect band slip, gastrojejunal stenosis
- arrange urgent bariatric surgical appointment
Port site infection in a band patient
- suspect gastric band erosion or infected band
- treat with antibiotics, arrange urgent bariatric surgical appointment
References and Links
FOAM and web resources
- FET — I Have Abdominal Pain and I Just Had Gastric Bypass Surgery by Mel Herbert (2013)
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC