BENIGN ANAL DISEASES AFTER BARIATRIC SURGERY
Oscar Santes*, Mario Trejo-Ávila, Jesús Morales-Maza, Tomás Patiño-Gómez, Danilo Solórzano Vicuna, Mauricio Sierra, Juan P. Pantoja, Noel Salgado-Nesme
Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Background
Bariatric procedures modify bowel habit. Many benign anal diseases (BAD) are associated with altered bowel habits. Evidence on the frequency of BAD after bariatric surgery is scarce.
Aim
Assess the incidence of BAD in patients who underwent bariatric surgery.
Material and Methods
A retrospective review of all patients who underwent bariatric surgery between 2010 and 2016 was performed. The preoperative characteristics, weight loss, bowel habits, the development of BAD (hemorrhoids, fissure or abscess/fistulae) following bariatric surgery and their treatment were collected from the clinical files. Constipation was defined as <3 bowel movements per week associated with abdominal discomfort; or any number of bowel movements plus hard stools, a feeling of incomplete evacuation, excessive straining, a sense of anorectal blockage or the need for manual maneuvers during defecation. Diarrhea was defined as >3 stools per day and abdominal discomfort, or increased liquidity of fecal evacuations. Symptoms had to be documented in at least three medical visits at follow-up.
Results
A total of 275 bariatric surgery patients were identified. The excluded patients comprised 17 who had a history of BAD before the bariatric surgery and 23 with incomplete information or follow-up less than six months. Among the 235 patients included, 171 were female (72.8%). Roux-en-Y gastric bypass (RYGB: biliopancreatic limb of 50 cm and alimentary limb 150 cm) and sleeve gastrectomy (SG) were performed in 210 (89.4%) and 25 (10.6%) patients, respectively. The mean age of the patients was 45.1 years (95% CI: 43.7-46.4). The mean follow-up was 41 months (95% CI: 38.0-44.1). The mean number of bowel movements per day was 2 (95% CI: 1.9-2.1). Normal bowel habit was reported in 186 (79.1%) patients, constipation in 36 (15.3%) and diarrhea in 13 (5.5%). No difference in bowel habit was found between the bariatric procedures (diarrhea 4.8% RYGB Vs. 12% SG, constipation 15.7% RYGB Vs. 12.0% SG, p=.309). BAD occurred in 9 (3.8%) patients. Hemorrhoids were diagnosed in 6 patients and abscess/fistulae in 3 patients. Surgical treatment for BAD was performed in 33.3% of the cases. Patients with BAD had altered bowel habit (100% constipation Vs. 0% diarrhea Vs. 0% normal, p<.001). There was no predominance of BAD regarding sex (2.9% females Vs. 6.2% males, p=.237) or bariatric surgery performed (3.8% RYGB Vs. 4.0% SG, p=.963). Furthermore, the age, preoperative BMI, change in BMI, percentage of total weight loss, percentage of excess weight loss, number of bowel movements and follow-up was not associated with the development of BAD (Table 1).
Conclusion
The development of BAD after RYGB and SG is rare. The limitation of this study lies in its retrospective nature. Prospective studies are required to confirm our findings.
Table 1. Characteristics of patients with and without BAD
| Variables | BAD (n=9) | No BAD (n=226) | P value |
| Age (years) | 52 (41-65) | 45 (22-74) | .119 |
| Preoperative BMI (kg/m2) | 42.2 (35.0-52.7) | 44.9 (28.6-84.1) | .505 |
| Change in BMI (kg/m2) | 9.2 (5.1-15.8) | 11.5 (2.4-40.2) | .990 |
| Total weight loss (%) | 21.7 (14.6-35.1) | 25.2 (5.8-65.5) | .990 |
| Excess weight loss (%) | 52.9 (47.6-78.9) | 57.2 (13.8-128.5) | .505 |
| Bowel movements per day | 1 (1-2) | 2 (0-6) | .472 |
| Follow-up (months) | 46 (12-69) | 37 (6-103) | .927 |
Data expressed as median (range)
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