THE ACUTE CARE SURGEONS’ EXPERIENCE OF COMPLICATIONS IN BARIATRIC
SURGERY
Joel F. Bradley III MD, Samuel W. Ross MD, A. Britton Christmas MD,
Gaurav Sachdev MD, B. Todd Heniford MD, Ronald F. Sing DO - Carolinas Medical Center
Background: Approximately 200,000 bariatric weight loss procedures are performed annually. Complications of
these procedures are common, can occur at any point during the patient’s lifetime, and can be life threatening. They
can also present rapidly and need acute surgical management. Our aim was to describe a series of bariatric surgical
complications that presented to our Acute Care Surgery service.
Methods: We reviewed our Acute Care Surgical Service at a quaternary referral center from Jan. 2007 to Dec. 2011
for patients presenting with a complication after bariatric surgery. Data collected included demographics, index
bariatric procedure, diagnosis, surgical intervention type, urgency of surgery, mortality, hospital length of stay
(LOS), and disposition. Descriptive statistics are reported as mean with standard deviation (continuous variable)
and percentages (categorical variable).
Results: This review identified 32 patients. The mean age was 42.3±10.6; 30 (94%) were female and mean body
mass index on presentation to the Acute Care Surgery Service was 31.7±9.0. Laparoscopic roux-en-y gastric bypass
(RyGB) was the most common index operation (N=20; 62%), followed by open RyGB (N=5; 16%), laparoscopic
gastric band (N=4; 12%), and vertical banded gastroplasty (N=3; 9%). Complication diagnoses included internal
hernia (N=9; 28%), lap band restriction (N=4; 12%), adhesive small bowel obstruction (N=3; 9%), gastric outlet
obstruction (N=3; 9%), biliary disease (N=3; 9%), upper GI bleeding or ulcer (N=3; 9%), ischemic bowel (N=1;
3%), anastomotic leak (N=1; 3%), and perforated ulcer (N=1; 3%). Operations were required in 29 (91%) patients.
Two (6%) were managed with endoscopy and one (3%) with band deflation. Of the operative treatment, 15 (52%)
were laparoscopic and 14 (48%) were managed by open operations. An emergent operation (<4 hours) was required
in 12 (39%) patients, while an additional five (16%) required an urgent operation (4-24 hours). All patients survived
and were discharged to home with a mean LOS of 6.8±7.9 days.
Conclusion: The acute care surgeon is at risk to encounter complications of bariatric surgery. The most common
presentations are internal hernias or obstructive etiologies that often require emergent or urgent surgery. Acute care
surgeons should be familiar with the anatomy of bariatric surgeries and the nuances of their complications. A
minimally invasive (laparoscopic) approach to surgical correction is frequently successful and should be a
fundamental part of the skill set of the acute care surgeon.