title: Incidence and management of bleeding complications after gastric bypass surgery in the morbidly obese.
abstract: BACKGROUND
  Bleeding after gastric bypass can be a life-threatening event and challenging to manage. With an increase in the number of bariatric procedures performed in recent years, it is important to be cognizant of the frequency, presentation, and management of this complication. The purpose of the present study was to evaluate the incidence and management of bleeding complications after gastric bypass surgery.
  
  
  METHODS
  A review of prospectively maintained bariatric surgery databases was conducted at 2 tertiary bariatric units. All patients who presented with gastrointestinal and intra-abdominal bleeding after gastric bypass during a 10-year period were identified, and their charts were reviewed.
  
  
  RESULTS
  A total of 4466 patients who underwent gastric bypass during the 10-year period had reliable morbidity data available and were included in the present study. Of the 4466 patients, 42 (.94%) experienced a bleeding complication postoperatively. Of these patients, 20 (47.6%) had undergone previous abdominal surgery. Bleeding occurred in the early postoperative period (<30 d) in 30 (71%); the etiology of which included bleeding from the staple lines, iatrogenic visceral injury, or mesenteric vessel bleeding. Early postoperative bleeding required operative intervention to achieve hemostasis in 43%. Late postoperative bleeding (n = 12) were usually secondary to marginal ulceration and warranted surgical intervention in 33.3%. Previously undiagnosed bleeding diatheses were identified in 14.3%.
  
  
  CONCLUSIONS
  Gastrointestinal bleeding after gastric bypass, although infrequent, is a difficult clinical scenario. Nonoperative management is feasible for hemodynamically stable patients. Surgical intervention is merited for patients with hemodynamic compromise, those who do not respond to transfusion, and those in whom the bleeding source cannot be adequately identified nonoperatively.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. heneghh@ccf.org
authors.forename: Helen M
authors.initials: HM
authors.lastname: Heneghan
authors.forename: Shai
authors.initials: S
authors.lastname: Meron-Eldar
authors.forename: Panduranga
authors.initials: P
authors.lastname: Yenumula
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rogula
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D024162:Second-Look Surgery; D017792:Surgical Stapling / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult