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home - Stomach - Obesity Surgery - Gastric Surgery Malabsorption Type Complications Written by Dr Sebastian Zeki
Knowledge


Describes the risks associated with obesity
Describes the dietary, pharmacological and surgical techniques
(including anatomical re-configuration) for managing obesity and their
associated medical and nutritional complications

Skills
Takes a relevant history and perform an appropriate examination in
order to be able to define level of obesity, identify potential
complications and arrange relevant investigations before referral to
an obesity service

Investigates and appropriately manages (in conjunction with surgical
and dietetic colleagues) patients admitted with complications from
bariatric surgery

Behaviours
Recognises obesity as an illness and will evaluate and treat the
patient in a sympathetic manner

Gastric Surgery Malabsorption Type Complications

Local Problems Other Abdominal Problems Internal herniasFrequency: 2.5%Roux-en-Y anatomy is associated with potential internal spaces through which herniation of the small intestine can occur.Three potential areas of internal herniation are between:Mesenteric defect at the jejuno-jejunostomyThe space between the transverse mesocolon and Roux-limb mesentery (Peterson's hernias)The defect in transverse mesocolon if the Roux-limb is passed retrocolicHernias through the transverse mesocolon are the most common and require operative treatment.Treatment: Surgical exploration Change in bowel habitsLoose stool/diarrhea more common after BPD and RYGB (46%).Constipation is more likely after gastric banding (40%). Ventral incisional herniaAssociated with open surgeryTreatment: Repair after significant weight loss has occurred (>1 year) CholelithiasisFrequency: 38 % of patients within 6m of surgery.Aetiology: Rapid weight loss causing increased the lithogenicity of bile+ pre-existing obesityTreatment: 6m course of UDCA/ prophylactic cholecys-tectomy at time of main surgery reduces incidence to 2% Marginal ulcersFrequency: 10%Causes of marginal ulcers include :-Poor tissue perfusion due to tension or ischemia at the anastomosis-Presence of foreign material, such as staples or nonabsorbable suture-Excess acid exposure in the gastric pouch due to gastrogastric fistulasNonsteroidal antiinflammatory drug useHelicobacter pylori infectionSmokingTreatment: Usually as per PUD Stomal stenosisFrequency: 10 %Cause: Tissue ischemia or increased tension on the gastrojejunal anastomosis Treatment: Endoscopic balloon dilation is usually successful- may need repeats. Wound infectionFrequency 10% with open 3% with closedReduced by closing fascia in running rather than interrupted manner Gastric remnant distensionIf there is cause for gastric remnant to distend (obstruction/ vagal fibre damage), can perforateCan be prevented by routine gastrostomy if there if concern this might happen (elderly, superobese patients, patients with advanced diabetes) LeaksAverage leak rate of 2.5%Treatment: Exploratory surgery- can use stent or glue sometimesBleedingFrequency: 2%.Cause: Intraluminal from staple lines. Usually no need for intervention Late bleeding from gastric remnant usually PUD Malabsorption Surgery Complications Systemic problems (See mixed obesity surgery complica-tions) Written by Dr Sebastian Zeki

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