title: Early postoperative hemorrhage after open and laparoscopic roux-en-y gastric bypass.
abstract: BACKGROUND
  Early postoperative hemorrhage is an infrequent complication of both laparoscopic and open Roux-en-Y gastric bypass (RYGBP). The objective of our study is to review the incidence and management of this complication and identify contributing clinical and technical risk factors.
  
  
  METHODS
  Over a 3-year period, 1,025 patients underwent RYGBP at our institution. The medical records of patients who required postoperative blood transfusions were reviewed for clinical presentation, diagnostic evaluation and management. These patients were matched for surgical approach (open vs. laparoscopic) in a 1:3 ratio and compared to a random group of patients who underwent RYGBP during the same time period.
  
  
  RESULTS
  Thirty-three patients (3.2%) were diagnosed with postoperative hemorrhage, 17 (51.5%) of which were intraluminal. The incidence of hemorrhage was higher in the laparoscopic group (5.1% vs. 2.4%, p = 0.02). Comparing bleeders to nonbleeders, the average BMI, gender distribution, gastro-jejunostomy anastomotic technique (stapled vs. hand sewn) and the postoperative administration of ketorolac were not significantly different. The bleeding group was older (47.5 vs. 42.8, p = 0.02), had a longer hospital stay (4.9 vs. 3 days, p = 0.0001) and was more likely to have received low molecular weight heparin (LMWH) preoperatively (p = 0.03). Hemorrhage occurred earlier (13.8 vs. 25.9 h, p = 0.039) and was more severe (4.1 vs. 2.3 transfused blood units, p = 0.007) in the patients who required surgical reexploration (n = 9).
  
  
  CONCLUSIONS
  A laparoscopic approach and the preoperative administration of LMWH may increase the incidence of early hemorrhage after RYGBP. This complication frequently requires surgical reexploration and significantly prolongs the hospital stay.
authors.affiliation: Department of Surgery, Hospital of Saint Raphael, MOB 315, 1450 Chapel Street, New Haven, CT, 06511, USA. charlesbakhos@hotmail.com.
authors.forename: Charles
authors.initials: C
authors.lastname: Bakhos
authors.affiliation: Department of Surgery, Hospital of Saint Raphael, MOB 315, 1450 Chapel Street, New Haven, CT, 06511, USA.
authors.forename: Fuad
authors.initials: F
authors.lastname: Alkhoury
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, 950 Campbell Avenue, VA CT Healthcare System, West Haven, CT, 06516, USA.
authors.forename: Tassos
authors.initials: T
authors.lastname: Kyriakides
authors.affiliation: Department of Surgery, Hospital of Saint Raphael, MOB 315, 1450 Chapel Street, New Haven, CT, 06511, USA.
authors.forename: Randolph
authors.initials: R
authors.lastname: Reinhold
authors.affiliation: Department of Surgery, Hospital of Saint Raphael, MOB 315, 1450 Chapel Street, New Haven, CT, 06511, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Nadzam
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D001803:Blood Transfusion; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight