Early Period Complications
Bleeding : Post operation may be bleeding from mesentric or omental vessels or from anostomosis stapler line into peritoneal cavity. The incidence is 0 – 4 %. The bleedings occuring by anostomosis line can be endoscopically identified and treated.
Anastomosis Leakage : This is the most to be considered among the complications. It can emerge at a very early period such as can be seen 5th day after the surgery. The incidence differs between the rang of 0 – 4.4 %. Tachycardia (over 120 minutes), tachypnea, high fever and oxygen saturation reducing those have developed at the patient post operation may be the signs of anostomosis leakage. In such a case it is necessary to assess the patient quickly and take abdominal CT and US if necessary and to define the location and the level of anostomosis leakage. Drainage, antibiotics treatment and surgical treatment when necessary must be applied.
Wound Infection : Wound infection is seen less at laparoscopic operations than open surgeries. Wound infection is less from 5% at the laparoscopic operations whereas this rate differs between 6-10 % at the open surgeries. These are easily recover with antibiotics treatment.
Thromboembolism : The more you have BMI value, the more you have risk of venous thromboembolism. Low molecule weight heparin assays those will begin at the operation day will be decrease this risk. Thrombosis development risk at the deep veins after Gastric Bypass operation is 0 – 1.3 % whereas pulmonary embolism risk is 0 – 1.1 %.
Anastomosis Stricture : Anostomosis stricture is seen at the range of 2-16% postoperation. The reason is depending more on experience of the surgeon performed the operation and the technics used for the anostomosis (hand-swen, lineer stapler or circular stapler). Marginal ulcers those have developed as a result of ischemia depending on the stress at the anostomosis line play important role at the stricture forming. The stricture reveals itself as nausea and vomiting at 3 months after the surgery. More than 85% of the anostomosis strictures can be treated by endoscopic dilatation.
Late Period Complications
Marginal Ulcer : This ulcer which has developed post operation is mostly occurs at GJ (gastrojejunostomy) line and generally at the jejunum part. The ischemia depending on the stress at anostomosis line and foreign materials (circular stapler metals and nonabsorbable suture materials) those have been used at this area have important role at forming of the marginal ulcer. On the other hand, nonsteroids anti-inflammatory (NSAID) drug using, smoking addiction and intense acid reflux at anostomosis area depending on gastrogastric fistula development are efective on the marginal ulcer development. Anemia as a result of abdominal paint, nausea-vomiting and sometimes bleeding is seen at these patients. Marginal ulser development is between 0.7 – 5.1 %. Drugs to prevent acid-forming, NSAIDs and giving up smoking are suggested for treatment. Rarely surgical intervention may be required at resistant ulcer.
Bowel Obstruction : The most important reasons of bowel obstruction are postoperative adhesions and internal herniation. The most important reason of advanced adhesion at the bowels may be based on too much manipulation with them during the operation. This type of adhesions is seen more at the open surgery applications. And the important reason of bowel obstruction depending on internal herniation is to not close the mesentric defects at enough level. Incidence of internal herniation is about 3%.
Gallbladder Stones : Incidence of gallbladder stones incerase with weight loss after Gastric Bypass. Gallbladder stones are indicated to develop at the range of 38-52% in the first year after the operation. However at 15% part of the patients those developed gallbladder stone colecistectomy by surgical treatment is required in the first 3 years. Colecistectomy is suggested at the same time with gastric bypass application if there are symptomatic gallbladder stones identified before the operation. On the other side colesistectomy at the surgery moment for asymotomatic gallbladder stones or for gallbladder without stone is not a much accepted concept. Some surgeons suggest prophylactic colesistectomy. But the most important disadvantage of this application is to may lead to unneccessary complications (hemorrhage, biliary tract woundings, prolonged surgery time) with a different surgical application during the operation.
Vitamin (Nutritional) Deficiency : Deficiency of iron, Vitamin B12 and some other nutritional elements is frequently experienced after Gastric Bypass surgery because the large part of the stomach, duodenum and the proximal part of the jejunum have been by-passed. Single dose vitamin tablet a day shoul be taken for this. Incidence of iron deficiency post operation differs in a range of 13-52 % in 2 – 5 years period. At the persons with iron deficiency, this need is met by iron tablet intake. In 37% of the patients Vitamin B12 deficiency may be encountered although multivitamin intake and in such a case the necessary treatment is provided by B12 suplementation. Calcium deficiency is seen at 10% of the patients whereas vitamin deficiency at 51%. Except these, secondary hyperparathyroidism may also develop and particularly after early surgical treatment increase bone turnover and decreased bone density may be defined in the first 3-9 moths period.
Mortality : In a meta-analysis executed by Buchwald et al. 136 studies have been evaluated. Mortality rate in first 30 days has been defined as 0.5% as a result of investigating a group of 22.094s patients those have underwent obesity surgery. In an other study has been executed by Podnos et al. Mortality rate at the patients those have underwent Gastric Bypass surgery has been found as 0% - 0.9%. In a review at JAMA journal, in a study has been realized by Zingmond et al. after evaluation of 60.077 patients those have underwent Gastric Bypass surgery, mortalite rate has been defined as 0.33% in first 30 days and 0.91% in first year.
Assoc. Prof. Halil Coskun M.D.
