Early and late complications after gastric bypass: A literature review

Authors

DOI:

https://doi.org/10.30978/GS-2021-1-60

Keywords:

obesity, bariatric surgery, gastric bypass, anastomotic leaks, small bowel obstruction, marginal ulceration, Petersen’s space hernia, gastrogastric fistula, weight regain

Abstract

Over the last few decades, excess weight and obesity have become a considerable health problem that has a lasting impact on communities worldwide. According to the WHO, about 1.9 billion people over the age of 18 are overweight [32]. Obesity accounted for about 4.7 million premature deaths in 2017. Globally, obesity was associated with an increase in mortality rate from 4.5 % in 1990 to 8 % in 2017 [32]. Bariatric surgery is currently recognized as the most effective treatment option for morbid obesity. Over the past 10 years, gastric bypass surgery has proved more effective than any other surgical methods due to its optimal metabolic effects.

The aim of the review is to carry out an analysis of literature data in order to identify main complications after gastric bypass in patients with obesity.

The complication rate after bariatric surgery decreased from 10.5 % in 1993 to 7.6 % in 2006 [3]. The mortality rate after bariatric surgery was 0.08 % within 30 days after surgery and 0.31 % after 30 days [13]. According to the BOLD study (2010), for 57,918 bariatric operations, the complication rate was 6,240 (10.77 %) and the mortality rate was 78 (0.135 %), within 30 days after surgery — 0.089 %, within 90 days after surgery — 0.112 %. Roux‑en‑Y Gastric Bypass (RYGB) was carried out in 30,864 cases, and 4,588 (14.87 %) patients developed postoperative complications. Early complications include anastomotic leaks (0 — 5,6 % for laparoscopic approach and 1,6 — 2,6 % — for laparotomy), small bowel obstruction caused by a blood clot (0 — 0,5 %), bleeding from the sutures (1,5 %), and thromboembolic complications (0,2 — 5 %). Late complications include stenosis of the gastrointestinal tract (3 — 27 %), marginal ulceration (MU) — 0,6 — 16 %, an incarcerated Petersen’s space hernia — 2,51 %, perforation of the stomach and small intestine (1 — 2 %), gastrogastric fistula formation — 1,5 — 6,0 %, weight regain (to 17,1 %).

Increasing global demand for bariatric surgery as the best option for the management of excess weight and obesity necessitates more detailed investigation of possible complications it may induce. Therefore, further research is required to develop and study new effective methods for prevention and treatment of complications after surgical treatment of patients with morbid obesity.

 

References

Afaneh C, Dakin GF. Enteric leaks after gastric bypass: prevention and management, in bariatric surgery complications and emergencies. In: Herron DM, editor. Springer, Switzerland 2016. p. 81-9.

Almby K, Edholm D. Anastomotic Strictures After Roux-en-Y Gastric Bypass: a Cohort Study from the Scandinavian Obesity Surgery Registry. Obes Surg. 2019 Jan;29(1):172-177.

Altieri MS, Pryor AD, Telem DA, Hall K, Brathwaite C, Zawin M. Algorithmic approach to utilization of CT scans for detection of internal hernia in the gastric bypass patient. Surg Obes Relat Dis. 2015 Nov-Dec;11(6):1207-11.

Angrisani L, et al. Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014. Obes Surg. 2017;27:2279-89.

Arteaga-Gonzalez I, et al. Usefulness of clinical signs and diagnostic tests for suspected leaks in bariatric surgery. Obes Surg. 2015;25(9):1680-4.

Ayloo SM, Addeo P, Buchs NC, Shah G, Giulianotti PC. Robot-assisted versus laparoscopic Roux-en-Y gastric bypass: is there a difference in outcomes? World J Surg. 2011;35:637-42.

Baumann AJ, Mramba LK, Hawkins RB, Carpenter AM, Fleisher MS, Ayzengart AL, Estores DS Jr. Endoscopic Dilation of Bariatric RNY Anastomotic Strictures: a Systematic Review and Meta-analysis. Obes Surg. 2018 Dec;28(12):4053-4063.

Bludau M, Hölscher AH, Herbold T, Leers JM, Gutschow C, Fuchs H, Schröder W. Management of upper intestinal leaks using an endoscopic vacuum-assisted closure system (E-VAC). Surg Endosc. 2014 Mar;28(3):896-901.

Camacho, D., & Zundel, N. (Eds.). Complications in Bariatric Surgery. 2018.

Carrodeguas L, Szomstein S, Soto F, et al. Management of gastrogastric fistulas after divided Roux-en-Y gastric bypass surgery for morbid obesity: analysis of 1,292 consecutive patients and review of literature. Surg Obes Relat Dis. 2005;1(5):467-74.

Carrodeguas L, Szomstein S, SotoF, et al. Management of gastro- gastric fistulas аfter divided Roux-en-Y gastric bypass surgery for morbid obesity: analysis of 1,292 consecutive patients and review of literature. Surg Obes Relat Dis 2005;1:467-74.

Chang J, Sharma G, Boulis M, Brethauer S, Rodriguez J, Endoscopic stents in the management of anastomotic complications after foregut surgery: new applications and techniques Surg Obes Relat Dis. 2016;12(7):1373-81.

Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275-287.

Cho M, Carrodeguas L, Pinto D, Lascano C, Soto F, Whipple O, Gordon R, Simpfendorfer C, Gonzalvo JP, Szomstein S, Rosenthal RJ. Diagnosis and management of partial small bowel obstruction after laparoscopic antecolic antegastric Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg. 2006;202(2):262-8.

Coblijn UK, Goucham AB, Lagarde SM, Kuiken SD, van Wagensveld BA. Development of ulcer disease after Roux-en-Y gastric bypass, incidence, risk factors, and patient presentation: a systematic review. Obes Surg. 2014;24(2):299-309.

Connor C, Thomas B, Pullatt R. Mesocolic Hernia: The Achilles Heel of the Retrocolic Gastric Bypass. Am Surg. 2015 Sep;81(9):e336-7. PMID: 26350651.

Cooper TC, Simmons EB, Webb K, Burns JL, Kushner RF. Trends in weight regain following Roux-en-Y gastric bypass (RYGB) bariatric surgery. Obes Surg. 2015;25(8):1474-81.

Corcelles R, Jamal MH, Daigle CR, Rogula T, Brethauer SA, Schauer PR. Surgical management of gastrogastric fistula. Surg Obes Relat Dis. 2015;11(6):1227-32.

Csendes A, Burgos AM, Braghetto I. Classification and management of leaks after gastric bypass for patients with morbid obesity: a prospective study of 60 patients. Obes Surg. 2012;22(6):855-62.

Csendes A, Burgos AM, Altuve J, Bonacic S. Incidence of marginal ulcer 1 month and 1 to 2 years after gastric bypass: a prospective consecutive endoscopic evaluation of 442 patients with morbid obesity. Obes Surg. 2009;19(2):135-8.

Da Costa M, Mata A, Espinós J, Vila V, Roca JM, Turró J, Ballesta C. Endoscopic dilation of gastrojejunal anastomotic strictures after laparoscopic gastric bypass. Predictors of initial failure. Obes Surg. 2011 Jan;21(1):36-41. doi: 10.1007/s11695-010-0154-7. PMID: 20396992.

Da Silva FB, Gomes DL, de Carvalho KM. Poor diet quality and postoperative time are independent risk factors for weight regain after Roux-en-Y gastric bypass. Nutrition. 2016;32(11-12):1250-3.

Davis PJ, Liu RY, Haardt D, Ellsmere J. Robotic versus laparoscopic Roux-en-Y gastric bypass (RYGB) in obese adults ages 18 to 65 years: a systematic review and economic analysis. Surg Endosc. 2014;28(2):414-26.

DeMaria EJ, Pate V, Warthen M, Winegar DA. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database. Surgery for Obesity and Related Diseases. 2010;6(4):347-355.

El-Hayek K, Timratana P, Shimizu H, Chand B. Marginal ulcer after Roux-en-Y gastric bypass: what have we really learned? Surg Endosc. 2012;26(10):2789-96.

El-Kadre L, et al. Overcoming the learning curve of laparoscopic Roux-en-Y gastric bypass: a 12-year experience. Surg Obes Relat Dis. 2013;9(6):867-72.

Felix EL, Kettelle J, Mobley E, Swartz D. Perforated marginal ulcers after laparoscopic gastric bypass. Surg Endosc. 2008;22(10):2128-32.

Fernandez AZ JrDeMaria EJTichansky DS et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc 2004;18(2) 193-197.

Fernandez-Esparrach G, Lautz DB, Thompson CC. Endoscopic repair of gastrogastric fistula after Roux-en-Y gastric bypass: a less-invasive approach. Surg Obes Relat Dis 2010;6(3):282-8.

Filho AJ, Kondo W, Nassif LS, Garcia MJ, Tirapelle Rde A, Dotti CM. Gastrogastric fistula: a possible complication of Roux-en-Y gastric bypass. JSLS. 2006;10(3):326-31.

Fridman A, Szomstein S, Rosenthal RJ. Postoperative bleeding in the bariatric surgery patient. In: Nguyen NT, Blackstone RP, Morton JM, Ponce J, Rosenthal RJ, editors. The ASMBS textbook of bariatric surgery: volume 1: bariatric surgery. New York: Springer Science+Business Media; 2015.

GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 8 Nov 2018;392:1923-94.

Geubbels N, Lijftogt N, Fiocco M, van Leersum NJ, Wouters MW, de Brauw LM. Meta-analysis of internal herniation after gastric bypass surgery. Br J Surg. 2015;102(5):451-60.

Goitein D, Papasavas PK, Gagné D, Ahmad S, Caushaj PF. Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2005;19(5):628-32.

Green J, Ikuine T, Hacker S, Urrego H, Tuggle K. Acute small bowel obstruction due to a large intraluminal blood clot after laparoscopic Roux-en-Y gastric bypass. J Surg Case Rep. 2016;2016(8):rjw143. Published 2016 Aug 23. doi:10.1093/jscr/rjw143.

Heneghan HM, Meron-Eldar S, Yenumula P, Rogula T, Brethauer SA, Schauer PR (2012) Incidence and management of bleeding complications after gastric bypass surgery in the morbidly obese. Surg Obes Relat Dis 8:729-735.

Joo MK. Endoscopic Approach for Major Complications of Bariatric Surgery. Clin Endosc. 2017 Jan;50(1):31-41. doi: 10.5946/ce.2016.140. Epub 2016 Dec 23. PMID: 28008162; PMCID: PMC5299989.

Iannelli A, Facchiano E, Gugenheim J. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 2006;16:1265-71.

Kalaiselvan R, Exarchos G, Hamza N, Ammori BJ. Incidence of perforated gastrojejunal anastomotic ulcers after laparoscopic gastric bypass for morbid obesity and role of laparoscopy in their management. Surg Obes Relat Dis. 2012;8:423-8.

Kane ED, Romanelli JR. Complications of Roux-en-Y gastric bypass. In: Reavis KM, Barrett AM, Kroh MD, editors. The SAGES manual of bariatric surgery. Cham: Springer International Publishing; 2018. p. 403-29.

Khalayleh H, Pines G, Imam A, Sapojnikov S, Buyeviz V, Mavor E. Anastomotic Stricture Rates Following Roux-en-Y Gastric Bypass for Morbid Obesity: A Comparison Between Linear and Circular-Stapled Anastomosis. J Laparoendosc Adv Surg Tech A. 2018 Jun;28(6):631-636.

Kim J, et al. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis. 2015;11(4):739-48.

Kravetz AJ, Reddy S, Murtaza G, Yenumula P. A comparative study of handsewn versus stapled gastrojejunal anastomosis in laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2011;25:1287-92.

Kumar N, Thompson CC. Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up. Gastrointest Endosc. 2016;83(4):776-9.

Lauti M, Stevenson S, Hill AG, MacCormick AD. Patient perspectives about follow-up care and weight regain following sleeve gastrectomy. Obes Surg. 2016;26(11):2724-31.

Lee JK, Van Dam J, Morton JM, Curet M, Banerjee S. Endoscopy is accurate, safe, and effective in the assessment and management of complications following gastric bypass surgery. Am J Gastroenterol 2009; 104:575-582.

Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, et al. Patient behaviors associated with weight regain after laparoscopic gastric bypass. Obes Res Clin Pract. 2011;5(3):e169-266.

Livingston EH. The incidence of bariatric surgery has plateaued in the U. S. Am J Surg. 2010;200(3):378-385.

Magro DO, Geloneze B, Delfini R, Pareja BC, Callejas F, Pareja JC. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18(6):648-51.

Maleckas A, Gudaityte R, Petereit R, Venclauskas L, Velickiene D. Weight regain after gastric bypass: etiology and treatment options. Gland Surg. 2016;5(6):617-24.

Meguid MM, Glade MJ, Middleton FA. Weight regain after Roux-en-Y: a significant 20 % complication related to PYY. Nutrition. 2008;24(9):832-42.

Mickevicius A, Sufi P, Heath D. Factors predicting the occurrence of a gastrojejunal anastomosis leak following gastric bypass. Wideochir Inne Tech Maloinwazyjne. 2014;9(3):436-40.

Nelson LG, Gonzalez R, Haines K, Gallagher SF, Murr MM. Spectrum and treatment of small bowel obstruction after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006 May-Jun;2(3):377-83, discussion 383. doi: 10.1016/j.soard.2006.02.013. PMID: 16925356.

Nguyen NT, Hinojosa MW, Gray J, Fayad C. Reoperation for marginal ulceration. Surg Endosc. 2007;21(11):1919-21.

Niland B, Brock A. Over-the-scope clip for endoscopic closure of gastrogastric fistulae. Surg Obes Relat Dis. 2017;13(1):15-20.

Obeid A, McNeal S, Breland M, Stahl R, Clements RH, Grams J. Internal hernia after laparoscopic Roux-en-Y gastric bypass. J Gastrointest Surg. 2014 Feb;18(2):250-5; discussion 255-6.

O'Rourke RW. Management strategies for internal hernia after gastric bypass. J Gastrointest Surg. 2011;15(6):1049-54.

Patel RA, Brolin RE, Gandhi A.Revisional operations for marginal ulcer after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2009; 5:317-22.

Pazouki A, Pakaneh M, Khalaj A, Tamannaie Z, Jangjoo A, Shapoori P, et al.. Blood bezoar causing obstruction after laparoscopic Roux-en-Y gastric bypass. Int J Surg Case Rep 2014;5:183-5.

Puig CA, Waked TM, Baron TH Sr, Wong Kee Song LM, Gutierrez J, Sarr MG. The role of endoscopic stents in the management of chronic anastomotic and staple line leaks and chronic strictures after bariatric surgery. Surg Obes Relat Dis. 2014 Jul-Aug;10(4):613-7. doi: 10.1016/j.soard.2013.12.018. Epub 2014 Jan 11. PMID: 24680763.

Ribeiro-Parenti L, De Courville G, Daikha A, Arapis K, Chosidow D, Marmuse JP. Classification, surgical management and outcomes of patients with gastrogastric fistula after Roux-En-Y gastric bypass. Surg Obes Relat Dis. 2016;

Riva P, Perretta S, Swanstrom L. Weight regain following RYGB can be effectively treated using a combination of endoscopic suturing and sclerotherapy. Surg Endosc. 2017;31(4):1891-5.

Salimath J, Rosenthal RJ, Szomstein S. Laparoscopic remnant gastrectomy as a novel approach for treatment of gastrogastric fistula. Surg Endosc. 2009;23(11):2591-5.

Santo MA, Riccioppo D, Pajecki D, Kawamoto F, de Cleva R, Antonangelo L, et al. Weight regain after gastric bypass: influence of gut hormones. Obes Surg. 2016;26(5):919-25.

Schiesser M, et al. Successful endoscopic management of gastrointestinal leakages after laparoscopic Roux-en-Y gastric bypass surgery. Dig Surg. 2014;31(1):67-70.

Shikora SA. The use of staple-line reinforcement during laparoscopic gastric bypass. Obes Surg 2004;14:1313-20.

Simillis C, Fachiri M, Bonanomi G. A challenging gastrointestinal hemorrhage after gastric bypass treated with interventional radiology. Surg Obes Relat Dis. 2016;12(7):e59-62.

Souto-Rodriguez R, Alvarez-Sanchez MV. Endoluminal solutions to bariatric surgery complications: a review with a focus on technical aspects and results. World J Gastrointest Endosc. 2017;9(3):105-26.

Spector D, Perry Z, Shah S, Kim JJ, Tarnoff ME, Shikora SA. Roux-en-Y gastric bypass: hyperamylasemia is associated with small bowel obstruction. Surg Obes Relat Dis. 2015;11(1):38-43.

Tamboli RA, Breitman I, Marks-Shulman PA, Jabbour K, Melvin W, Williams B, et al. Early weight regain after gastric bypass does not affect insulin sensitivity but is associated with elevated ghrelin. Obesity (Silver Spring). 2014;22(7):1617-22.

Tran DD, Nwokeabia ID, Purnell S, Zafar SN, Ortega G, Hughes K, et al. Revision of Roux-En- Y gastric bypass for weight regain: a systematic review of techniques and outcomes. Obes Surg. 2016;26(7):1627-34.

Wernick B, Jansen M, Noria S, Stawicki SP, El Chaar M. Essential bariatric emergencies for the acute care surgeon. Eur J Trauma Emerg Surg. 2016;42(5):571-84.

Uchima H, Abu-Suboh M, Mata A, Cruz M, Espinos J. Lumen-apposing metal stent for the treatment of refractory gastrojejunal anastomotic stricture after laparoscopic gastric bypass. Gastrointest Endosc. 2016;83(1):251.

Yanos BR, Saules KK, Schuh LM, Sogg S. Predictors of lowest weight and long-term weight regain among Roux-en-Y gastric bypass patients. Obes Surg. 2015;25(8):1364-70.

Zafar SN, Miller K, Felton J, Wise ES, Kligman M. Postoperative bleeding after laparoscopic Roux en Y gastric bypass: predictors and consequences. Surg Endosc. 2019 Jan;33(1):272-280.

Downloads

Published

2021-12-23

How to Cite

1.
Nevmerzhytskyi V. Early and late complications after gastric bypass: A literature review. ЗХ [Internet]. 2021Dec.23 [cited 2024Dec.9];(1):60—66. Available from: http://generalsurgery.com.ua/article/view/247659

Issue

Section

Reviews