see: [Rosen - Bariatric surgery](x-devonthink-item://FFBED145-CA8C-4696-83E6-B38885D4B926?page=3), [AFP Bariatric surgery: A guide for the primary care physician](https://www.racgp.org.au/afp/2017/july/bariatric-metabolic-surgery-a-guide-for-the-primar) see also: [[complications of general surgery]] #radiology ![[Pasted image 20240911130955.png]] ![[Pasted image 20240911131011.png| roux-en-Y gastric bypass procedure]] # Outcomes improvement in diabetes, cardiovascular disease, NAFLD, OSA, and intracranial HTN post bariatric surgery # Complications | procedure | early complication | late complication | | ------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------- | | laparoscopic gastric band | - esophageal perforation<br>- gastric perforation<br>- gastric dilation | - tubing failure<br>- port infection<br>- gastric erosion<br>- pocket dilation with late slippage | | sleeve gastrectomy | - gastric leak<br>- fistulae formation | - GORD<br>- dumping syndrome | | gastric bypass | - staple line leak<br>+/- fistula<br>- jejuno-jejunostomy obstruction<br>- gastro-jejunostomy obstruction<br>- post-op bleeding<br>marginal ulcers | - marginal ulcers<br>- internal herniation +/- obstruction<br>- adhesions w/ obstruction<br>- cholelithiasis<br>- dumping syndrome | ![[Pasted image 20240911132028.png]] from [tintinalli complications of gastric bypass procedures](x-devonthink-item://3AC86672-A078-47D7-98C9-4889428EE94A?page=87) General list of complications: - dumping syndrome - anastomotic leak - infection - performation - malnutrition - reflux - bowel obstruction - hypoglycaemia - gallstones - hernias - chronic nausea/vomiting ## dumping syndrome - large bolus of partially digested food is rapidly released into the small bowel - leads to abdo pain, bloating, nausea, borborygmi, vomiting - rapid fluid shifts can result in flushing, palpitations, fatigue, transient hypotension, tachycardia, diaphoresis - late dumping syndrome (1-3 hours post meal) may have some hypoglycaemia, weakness, hunger, and adrenergic surge - treatment: diet, small frequent meals, elimination of refined sugar, delayed fluid intake until 30 min post meal ## lap band complications - *lap band slippage* evinced by elevated phi angle - phi angle usually 4-48 deg - formed by a straight line through the long axis of the band and vertical line through the spinal column ![[Pasted image 20240911131430.png| image on left shows a slipped lap band on abdominal XR ; image on right shows normal phi angle]]