Complications
Partly as a result of eating too much or too rapidly. Tissue oedema also contributes to the short-term complication.
Post-bariatric surgery dietary instruction is important to avoid overeating. Patients can be reassured once other causes of nausea and vomiting are ruled out.[256]
Atelectasis and subsequent pneumonia are the most common pulmonary complications. Due to incisional pain, patients tend to take blunted and shallow breaths. With the use of adequate analgesia, early ambulation, the use of an incentive spirometer, and deep breathing/cough exercises, the frequency of atelectasis can be decreased.[257]
Due to surgical technical error. Non-operative management if patient is clinically stable and bleeding is not ongoing. Surgical treatment if conservative management fails.
Due to intestinal contamination (especially common in gastric bypass) or break in surgical sterile technique. Wound cellulitis can be treated with antibiotics; purulent drainage from wounds will require re-opening. If associated with a foreign body (gastric band placement), removing the band may be necessary.
Can occur frequently if the vagus nerve is divided during a gastric bypass. Patients with dumping syndrome should avoid ingestion of concentrated sugars.[261]
Due to tissue ischaemia or technical error. Early diagnosis and surgical intervention is the key in limiting the morbidity associated with this complication.
Most commonly due to pulmonary embolism or intestinal leak in the post-operative period.
Obesity is associated with the condition non-alcoholic fatty liver disease (NAFLD).
NAFLD has a broad spectrum of manifestations, ranging from simple fatty liver to hepatic steatosis with inflammation, advanced fibrosis, and end-stage liver disease.[243]
Central obesity is one of the risk factors for the metabolic syndrome (defined as the combination of central obesity/increased waist circumference, hypertension, dyslipidaemia, and fasting hyperglycaemia).
Obesity and cancer have a well-documented association, and obesity is now an acknowledged risk factor for certain types of cancer, including breast (post-menopausal), endometrium, colon, kidney, liver, and oesophagus.[244][245] Bariatric surgery is associated with a significantly reduced risk of obesity-related cancer and cancer-related mortality.[246]
Irritation in the folds of the skin. Affected areas are typically red and macerated.
Treatment consists of good hygiene combined with mild emollients. Topical corticosteroids can be used as necessary. Antimicrobial ointments may be used for superimposed bacterial or fungal infections.[253]
More likely in malabsorptive procedures; vitamin supplementation should include medically managed fat-soluble vitamin supplements A, D, E, and K.
Monitoring during post-operative period until stable is necessary.
Effects of bariatric surgery on drug absorption appear to be drug specific. Drugs found to exhibit the greatest potential for malabsorption were those that are intrinsically poorly absorbed, highly lipophilic, and/or undergo enterohepatic recirculation. Individual dose adjustment and therapeutic monitoring may be required.[254]
Obesity is associated with certain pregnancy complications, such as gestational diabetes, pre-eclampsia, and pregnancy-induced hypertension. Women who have undergone bariatric surgery may have less risk of these complications. There is no evidence that bariatric surgery is associated with increased caesarean section rates or delivery complications. Fertility may improve after bariatric surgery as well.[255]
Due to incisions made in the muscle and fascia of the anterior abdominal wall. Incidence is lower with laparoscopic surgery. Incisional hernias should be repaired when diagnosed, due to risk of incarceration and strangulation of intestinal contents.
Due to mesenteric defect associated with gastric bypass procedure. Operative repair is necessary when diagnosed due to risk of bowel ischaemia and necrosis.
Due to perigastric dissection technique used early in the gastric band placement experience. The rate of slippage is much lower when the pars flaccida technique is used. When diagnosed, surgical revision is necessary.[220]
In the short term, this complication is a result of bowel injury during the gastric band placement. In the long term, it is likely due to the inherent nature of a foreign body. Prompt surgical intervention is necessary on diagnosis.
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