title: Essential bariatric emergencies for the acute care surgeon.
abstract: Bariatric surgery is the most effective treatment for morbid obesity. Due to the high volume of weight loss procedures worldwide, the general surgeon will undoubtedly encounter bariatric patients in his or her practice. Liberal use of CT scans, upper endoscopy and barium swallow in this patient population is recommended. Some bariatric complications, such as marginal ulceration and dyspepsia, can be effectively treated non-operatively (e.g., proton pump inhibitors, dietary modification). Failure of conservative management is usually an indication for referral to a bariatric surgery specialist for operative re-intervention. More serious complications, such as perforated marginal ulcer, leak, or bowel obstruction, may require immediate surgical intervention. A high index of suspicion must be maintained for these complications despite "negative" radiographic studies, and diagnostic laparoscopy performed when symptoms fail to improve. Laparoscopic-assisted gastric band complications are usually approached with band deflation and referral to a bariatric surgeon. However, if acute slippage that results in gastric strangulation is suspected, the band should be removed immediately. This manuscript provides a high-level overview of all essential bariatric complications that may be encountered by the acute care surgeon.
authors.affiliation: Department of Surgery, St. Luke's University Health Network, NW2 Administration, 801 Ostrum Street, Bethlehem, PA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Wernick
authors.affiliation: Department of Surgery, St. Luke's University Health Network, NW2 Administration, 801 Ostrum Street, Bethlehem, PA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Jansen
authors.affiliation: Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: S
authors.initials: S
authors.lastname: Noria
authors.affiliation: Department of Surgery, St. Luke's University Health Network, NW2 Administration, 801 Ostrum Street, Bethlehem, PA, USA. stanislaw.stawicki@sluhn.org.
authors.forename: S P
authors.initials: SP
authors.lastname: Stawicki
authors.affiliation: Department of Surgery, St. Luke's University Health Network, NW2 Administration, 801 Ostrum Street, Bethlehem, PA, USA.
authors.forename: M
authors.initials: M
authors.lastname: El Chaar
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods; D015992:Body Mass Index; D003422:Critical Care / Q000379:methods*; D005548:Foreign-Body Migration; D005705:Gallbladder Diseases; D005747:Gastric Fistula; D006801:Humans; D007415:Intestinal Obstruction; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013276:Stomach Ulcer; D066231:Surgeons; D016896:Treatment Outcome
keywords: Bariatric surgery; Clinical management; Complications; Emergency treatment; General surgeon