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Canadian Journal of Surgery -

Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity

Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity

Can J Surg 2012;55(5):329-336 | PDF

P. Sahle Griffith, MBBS MRCS DM*; Daniel W. Birch, MSc MD*; Arya M. Sharma, MD PhD†; Shahzeer Karmali, MD*

From the *Department of Surgery and the †Department of Medicine, University of Alberta, Edmonton, Alta.

Abstract

Obesity has become a major health concern in Canada. This has resulted in a steady rise in the number of bariatric surgical procedures being performed nationwide. The laparoscopic Roux-en-Y gastric bypass (LRYGB) is not only the most common bariatric procedure, but also the gold standard to which all others are compared. With this in mind, it is imperative that all gastrointestinal surgeons understand the LRYGB and have a working knowledge of the common postoperative complications and their management. Early postoperative complications following LRYGB that demand immediate recognition include anastomotic or staple line leak, postoperative hemorrhage, bowel obstruction and incorrect Roux limb reconstructions. Later complications may be challenging to differentiate from other gastrointestinal disorders and include anastomotic stricture, marginal ulceration, fistula formation, weight gain and nutritional deficiencies. We discuss the principles involved in the management of each complication and the timing of referral to specialist bariatric centres.

Résumé

L’obésité est devenue un problème de santé majeur au Canada. Le phénomène està l’origine d’une augmentation constante du nombre de chirurgies bariatriques effectuées partout au pays. La dérivation gastrique laparoscopique Roux-en-Y n’est pas seulement la technique bariatrique la plus courante, elle est aussi la norme à laquelle toutes les autres se comparent. Compte tenu de cela, il est crucial que tous les spécialistes en chirurgie digestive comprennent cette intervention et aient une connaissance pratique de ses complications postopératoires fréquentes et de leur prise en charge. Les complications postopératoires immédiates de cette technique qu’il faut reconnaître sans tarder incluent : la fuite anastomotique (le long de la ligne d’agrafes), l’hémorragie postopératoire, l’obstruction intestinale et les reconstructions incorrectes de la branche Roux. Les complications tardives peuvent être difficiles à distinguer des autres troubles gastro-intestinaux et comprennent, notamment : la sténose anastomotique, l’ulcération marginale, la formation de fistules, l’échec de la perte pondérale et certains déficits nutritionnels. Nous discutons ici les principes qui sous-tendent la prise en charge de chaque complication et le moment où il est indiqué d’adresser les patients vers des centres spécialisés en soins bariatriques.


Accepted for publication Dec. 5, 2011

Acknowledgements: We thank Lesley Priestley, Coding Analyst, Health Records, London Health Sciences Center University Campus and Kathryn Barber, HIM Professional, Health Information and Privacy Department, London Health Sciences Centre University Campus.

Competing interests:None declared for P.S. Griffith, A.M. Sharma and S. Karmali. D.W. Birch declares having received consulting fees from Johnson & Johnson, Ethicon Endo-Surgery, Covidien and Baxter, as well as speaker fees from Covidien and Baxter.

Contributors: All authors designed the review, reviewed the article and approved its publication. P.S. Griffith acquired the data. P.S. Griffith and S. Karmali analyzed the data and wrote the article.

DOI: 10.1503/cjs.002011

Correspondence to: S. Karmali, 405 CSC 10240 Kingsway Ave., Edmonton AB T5H 3V9, shahzeer@ualberta.ca