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


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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