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Managing Complications After Bariatric Surgery: a Decade of Outcomes After Laparoscopic Intervention
Monica Young*, Alana Gebhart, Michael J. Hui, Brian R. Smith, Ninh T. Nguyen
Surgery, University of California Irvine Medical Center, Orange, CA
Introduction: With obesity rates continuing to rise in the United States, the volume of bariatric operations has been exponentially increasing. A natural consequence of this has been a growing number of revisional surgeries being performed for the management of complications. The objective of this study was to analyze outcomes of laparoscopic intervention for the management of complications after bariatric surgery.
Methods: A retrospective review of data collected from an academic medical center between 2003 and 2013 was performed. All patients who underwent laparoscopic surgical intervention for the management of a complication after bariatric surgery were included. The efficacy of the intervention and its associated perioperative morbidity and mortality were analyzed. Statistical analysis was performed using two-sample t-test with unequal variance and binary outcomes were compared using Fisher's exact test. GraphPad Software, Inc 2013 was used. Minimal duration of follow-up was 30 days.
Results: 91 consecutive patients who underwent laparoscopic surgery for obstruction (52.7%), bleeding (15.4%), abdominal pain (18.7%) and leak or band erosion (13.2%) were identified. Mean age was 48 years and 74% of patients were female. The mean body mass index at the time of revisional surgery was 35.7 kg/m2 and ASA was 2.9. The mean amount of time between index bariatric operation and surgical intervention was 46.4 months. Initial bariatric procedures included gastric bypass (58.2%), band (27.5%), sleeve (8.8%) and vertical banded gastroplasty (5.5%). Mean operative time of all interventions was 112 minutes. There were no conversions to open laparotomy. Average estimate blood loss was 25 cc and two patients required a blood transfusion. Three patients (3%) were monitored in the Intensive Care Unit postoperatively. Mean overall duration of hospital stay was 4 days. The efficacy of the reoperation procedure was 100% for obstruction, bleeding, and abdominal pain. However, the efficacy of laparoscopic revision after leak was 80%, with 20% of patients developing a persistent leak requiring additional stent placement. Overall morbidity of laparoscopic intervention was 4.4%. Complications included stricture, abscess, obstruction and venous thromboembolism. There were no perioperative mortalities.
Conclusion: The use of laparoscopic surgery to manage bariatric complications is feasible, safe and effective.
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