Prevention of bariatric complications: best practices

Abstract

The prevalence of obesity in both the United States and worldwide has grown significantly over the last several decades. With this growing pandemic, more patients are seeking surgical alternatives to achieve weight loss goals. Bariatric surgery has multiple proven health benefits, including weight loss and resolution of several co-morbidities, including diabetes. Advances in surgical techniques, including laparoscopy, have allowed bariatric surgery to increase in popularity among obese patients. However, bariatric surgery is not without complications. Key to successful weight loss surgery includes appropriate pre-operative laboratory workup, a multidisciplinary approach with other health care providers, proper peri-operative techniques as well as close post-operative follow up. This article will highlight several important criteria bariatric surgeons should bear in mind when evaluating patients in pre-operative, peri-operative and post-operative states to help prevent common complications seen in weight loss surgery.

Keywords

Bariatric complications / prevention / best practices / nutrition / ulcers / DVT

References

[1] Contival N,Gautier T,Alves A.Guiding the non-bariatric surgeon through complications of bariatric surgery.J Visc Surg2018;155:27-40

[2] Center for disease control and prevention. Adult obesity facts. Available from: https://www.cdc.gov/obesity/data/adult.html [Last accessed on Mar 21 2022]

[3] American Society for Metabolic and Bariatric Surgery. Estimate of bariatric surgery numbers, 2011-2019. Available from: https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers [Last accessed on Mar 21 2022]

[4] Telem DA,Schauer PR,Rosenthal RJ,Jones SB.Updated panel report: best practices for the surgical treatment of obesity. Surg Endosc 2018;32:4158-64.

[5] Lim RB,Jones DB.Benchmarking best practices in weight loss surgery.Curr Probl Surg2010;47:79-174 PMCID:PMC3134527

[6] Johansson K,Näslund I.Outcomes of pregnancy after bariatric surgery.N Engl J Med2015;372:814-24

[7] Mechanick JI,Brethauer S.Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American association of clinical endocrinologists/American college of endocrinology, the obesity society, American society for metabolic & bariatric surgery, obesity medicine association, and American society of anesthesiologists*.Executive Summary2019;25:1346-59

[8] Yen YC,Tai CM.Psychiatric aspects of bariatric surgery.Curr Opin Psychiatry2014;27:374-9 PMCID:PMC4162326

[9] Rutledge T,Savu M.Psychiatric factors and weight loss patterns following gastric bypass surgery in a veteran population.Obes Surg2011;21:29-35 PMCID:PMC3008931

[10] Peacock JC.Survey of bariatric surgical patients’ experiences with behavioral and psychological services.Surg Obes Relat Dis2012;8:777-83

[11] Kong WT,Kopf M.Perioperative risks of untreated obstructive sleep apnea in the bariatric surgery patient: a retrospective study.Obes Surg2016;26:2886-90

[12] Carter J,Birriel TJ.ASMBS position statement on preoperative patient optimization before metabolic and bariatric surgery.Surg Obes Relat Dis2021;17:1956-76

[13] Haskins IN,Vaziri K.The effect of smoking on bariatric surgical outcomes.Surg Endosc2014;28:3074-80

[14] Chow A,Kolozsvari N.Smoking in bariatric surgery: a systematic review.Surg Endosc2021;35:3047-66

[15] Horwitz D,Ude-Welcome A.Insurance-mandated medical weight management before bariatric surgery.Surg Obes Relat Dis2016;12:496-9

[16] Look AHEAD Research GroupEight-year weight losses with an intensive lifestyle intervention: the look AHEAD study.Obesity (Silver Spring)2014;22:5-13 PMCID:PMC3904491

[17] Weimann A,Oberänder N.Willing to go the extra mile: prospective evaluation of an intensified non-surgical treatment for patients with morbid obesity.Clin Nutr2019;38:1773-81

[18] Helm MC,Higgins R,Gould JC.Perioperative complications increase the risk of venous thromboembolism following bariatric surgery.Am J Surg2017;214:1135-40

[19] Finks JF,Carlin AM.Michigan Bariatric Surgery CollaborativeCenter for Healthcare Outcomes And PolicyPredicting risk for venous thromboembolism with bariatric surgery: results from the Michigan bariatric surgery collaborative.Ann Surg2012;255:1100-4

[20] Birkmeyer NJ,Carlin AM.Michigan Bariatric Surgery CollaborativeComparative effectiveness of unfractionated and low-molecular-weight heparin for prevention of venous thromboembolism following bariatric surgery.Arch Surg2012;147:994-8

[21] Demeusy A,Averbach A.Current role of staple line reinforcement in 30-day outcomes of primary laparoscopic sleeve gastrectomy: an analysis of MBSAQIP data, 2015-2016 PUF.Surg Obes Relat Dis2018;14:1454-61

[22] Rosenthal RJ,Arvidsson D.International Sleeve Gastrectomy Expert PanelInternational Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of > 12,000 cases.Surg Obes Relat Dis2012;8:8-19

[23] Aurora AR,Saber AA.Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients.Surg Endosc2012;26:1509-15

[24] Atkins ER,Jarman C.Improved obesity reduction and co-morbidity resolution in patients treated with 40-French bougie versus 50-French bougie four years after laparoscopic sleeve gastrectomy. Analysis of 294 patients.Obes Surg2012;22:97-104

[25] Comeau E,Inabnet WB,Quinn TM.Symptomatic internal hernias after laparoscopic bariatric surgery.Surg Endosc2005;19:34-9

[26] Marcotte E.Management and prevention of surgical and nutritional complications after bariatric surgery.Surg Clin North Am2016;96:843-56

[27] Hajibandeh S,Abdelkarim M.Closure versus non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass: a systematic review and meta-analysis.Surg Endosc2020;34:3306-20

[28] Magouliotis DE,Tasiopoulou VS,Zacharoulis D.Closure of mesenteric defects in laparoscopic gastric bypass: a meta-analysis.Obes Surg2020;30:1935-43

[29] Harakeh AB, Kallies KJ, Borgert AJ, Kothari SN. Bowel obstruction rates in antecolic/antegastric versus retrocolic/retrogastric Roux limb gastric bypass: a meta-analysis.Surg Obes Relat Dis2016;12:194-8

[30] Stuart A.Risk of abdominal surgery in pregnancy among women who have undergone bariatric surgery.Obstet Gynecol2017;129:887-95

[31] Petersen L,Svare J.The impact of upper abdominal pain during pregnancy following a gastric Bypass.Obes Surg2017;27:688-93

[32] Leal-González R,Guajardo-Pérez H,Rumbaut R.Internal hernias in pregnant women with history of gastric bypass surgery: case series and review of literature.Int J Surg Case Rep2013;4:44-7 PMCID:PMC3537949

[33] Parrott J,Rabena R,Isom KA.American society for metabolic and bariatric surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 update: micronutrients.Surg Obes Relat Dis2017;13:727-41

[34] Vimaleswaran KS,Lu C.Genetic Investigation of Anthropometric Traits-GIANT ConsortiumCausal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts.PLoS Med2013;10:e1001383 PMCID:PMC3564800

[35] Rhode BM,Christou NV.Iron absorption and therapy after gastric bypass.Obes Surg1999;9:17-21

[36] Lupoli R,Saldalamacchia G,Angrisani L.Bariatric surgery and long-term nutritional issues.World J Diabetes2017;8:464-74 PMCID:PMC5700383

[37] Sallé A,Poirier AL.Zinc deficiency: a frequent and underestimated complication after bariatric surgery.Obes Surg2010;20:1660-70

[38] Coblijn UK,Lagarde SM,van Wagensveld BA.Development of ulcer disease after Roux-en-Y gastric bypass, incidence, risk factors, and patient presentation: a systematic review.Obes Surg2014;24:299-309

[39] Mocanu V,Ladak F,Birch DW.Predictors and outcomes of leak after Roux-en-Y gastric bypass: an analysis of the MBSAQIP data registry.Surg Obes Relat Dis2019;15:396-403

[40] Alizadeh RF,Inaba C.Risk factors for gastrointestinal leak after bariatric surgery: MBASQIP analysis.J Am Coll Surg2018;227:135-41

[41] Zafar SN,Felton J,Kligman M.Postoperative bleeding after laparoscopic Roux en Y gastric bypass: predictors and consequences.Surg Endosc2019;33:272-80

[42] Gupta A,Kalaskar SN.Late postoperative bleeding after Roux-en-Y gastric bypass: management and review of literature.BMJ Case Rep2018;11:e226271 PMCID:PMC6301526

[43] Mora F,Mora M,Minguez M.Esophageal abnormalities in morbidly obese adult patients.Surg Obes Relat Dis2016;12:622-8

[44] Miller AT,Abu Dayyeh BK.Postobesity surgery esophageal dysfunction: a combined cross-sectional prevalence study and retrospective analysis.Am J Gastroenterol2020;115:1669-80

[45] Bevilacqua LA,Yang J.Incidence of GERD, esophagitis, Barrett's esophagus, and esophageal adenocarcinoma after bariatric surgery.Surg Obes Relat Dis2020;16:1828-36

[46] Schlottmann F,Patti MG.Bariatric surgery and gastroesophageal reflux.J Laparoendosc Adv Surg Tech A2018;28:953-5

[47] Gemici E,Seyit H.Outcomes of laparoscopic sleeve gastrectomy by means of esophageal manometry and pH-metry, before and after surgery.Wideochir Inne Tech Maloinwazyjne2020;15:129-35 PMCID:PMC7020704

[48] Tack J.Complications of bariatric surgery: dumping syndrome, reflux and vitamin deficiencies.Best Pract Res Clin Gastroenterol2014;28:741-9

[49] Beek AP, Emous M, Laville M, Tack J. Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management.Obes Rev2017;18:68-85

[50] Tack J,Caenepeel P,Bisschops R.Pathophysiology, diagnosis and management of postoperative dumping syndrome.Nat Rev Gastroenterol Hepatol2009;6:583-90

[51] Arts J,Bisschops R.Efficacy of the long-acting repeatable formulation of the somatostatin analogue octreotide in postoperative dumping.Clin Gastroenterol Hepatol2009;7:432-7

[52] Nicoletti CF,Barbin R,Salgado Junior W.Red meat intolerance in patients submitted to gastric bypass: a 4-year follow-up study.Surg Obes Relat Dis2015;11:842-6

[53] de A Godoy CM,de Godoy EP,Coelho D,de Oliveira AMG.Food Tolerance and Eating Behavior After Roux-en-Y Gastric Bypass Surgery.Obes Surg2018;28:1540-45