title: Complications of bariatric surgery: Presentation and emergency management.
abstract: The epidemic in obesity has led to an increase in number of so called bariatric procedures. Doctors are less comfortable managing an obese patient after bariatric surgery. Peri-operative mortality is less than 1%. The specific feature in the obese patient is that the classical signs of peritoneal irritation are never present as there is no abdominal wall and therefore no guarding or rigidity. Simple post-operative tachycardia in obese patients should be taken seriously as it is a WARNING SIGNAL. The most common complication after surgery is peritonitis due to anastomotic fistula formation. This occurs typically as an early complication within the first 10 days post-operatively and has an incidence of 1-6% after gastric bypass and 3-7% after sleeve gastrectomy. Post-operative malnutrition is extremely rare after restrictive surgery (ring, sleeve gastrectomy) although may occur after malabsorbative surgery (bypass, biliary pancreatic shunt) and is due to the restriction and change in absorption. Prophylactic cholecystectomy is not routinely carried out during the same procedure as the bypass. Superior mesenteric vein thrombosis after bariatric surgery is a diagnosis which should be considered in the presence of any postoperative abdominal pain. Initially a first etiological assessment is performed (measurement of antithrombin III and of protein C and protein S, testing for activated protein C resistance). If the least doubt is present, a medical or surgical consultation should be requested with a specialist practitioner in the management of obese patients as death rates increase with delayed diagnosis.
authors.affiliation: Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Etienne, France. Electronic address: Radwankassir42@hotmail.Fr.
authors.forename: Radwan
authors.initials: R
authors.lastname: Kassir
authors.affiliation: Department of Bariatric Surgery, Hospital Archet 2, Nice, France.
authors.forename: Tarek
authors.initials: T
authors.lastname: Debs
authors.affiliation: Department of Bariatric Surgery, Clinique chirurgicale mutualiste, Saint Etienne, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Blanc
authors.affiliation: Department of Bariatric Surgery, Hospital Archet 2, Nice, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Gugenheim
authors.affiliation: Department of Bariatric Surgery, Hospital Archet 2, Nice, France.
authors.forename: Imed
authors.initials: I
authors.lastname: Ben Amor
authors.affiliation: Department of Radiology, CHU Hospital, Jean Monnet University, Saint Etienne, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Boutet
authors.affiliation: Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Etienne, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Tiffet
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D005402:Fistula / Q000209:etiology; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D044342:Malnutrition / Q000209:etiology; D009765:Obesity / Q000601:surgery*; D010538:Peritonitis / Q000209:etiology; D011183:Postoperative Complications; D013610:Tachycardia / Q000209:etiology
keywords: Complications; Emergencies; Malnutrition; Obesity surgery; Vitamin D