Gastrointestinal Complications After Bariatric Surgery

Abstract

Bariatric surgery is increasingly being performed in the medically complicated obese population as convincing data continue to mount, documenting the success of surgery not only in achieving meaningful weight loss but also in correcting obesity-related illnesses. Several surgical procedures with varying degrees of success and complications are currently being performed. This article discusses the short- and long-term gastrointestinal complications for the 4 most common bariatric surgical procedures: laparoscopic adjustable gastric banding, vertical sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch.

Keywords: Bariatric surgery; biliopancreatic diversion; duodenal switch; gastric bypass; gastrointestinal complications; vertical sleeve gastrectomy.

Figure 1

Laparoscopie adjustable gastric banding (A) and vertical sleeve gastrectomy (B).

Figure 2

Before (A) and after (B) biliopancreatic diversion with duodenal switch.

Figure 3

Roux-en-Y gastric bypass.

Figure 4

Abdominal radiographs of laparoscopic adjustable gastric banding showing appropriate positioning at an approximately 45-degree angle (A), a slipped band with an overly vertical position (B), and a slipped band with an overly horizontal position (C).

Figure 5

An abdominal contrast radiograph showing a gastric tube stricture after vertical sleeve gastrectomy.

Figure 6

A coronal computed tomography image obtained 1 month after Roux-en-Y gastric bypass demonstrating gastric distention (large arrow) and residual contrast in the colon (small arrow), which is consistent with biliopancreatic limb obstruction. Contrast in the colon is from an earlier upper gastrointestinal barium evaluation that did not demonstrate the obstruction.

Figure 7

A computed axial tomography image revealing intussusception in the left abdomen 1 year after Roux-en-Y gastric bypass.

Figure 8

An algorithm for the evaluation of abdominal pain after gastric bypass. Surgical exploration should be considered when pain persists even without findings from the studies listed in the algorithm. CT, computed tomography; EGD, esophagogastroduodenoscopy; IV, intravenous; PPI, proton pump inhibitor; UGI, upper gastrointestinal.