Minimally invasive alternatives to “open” surgical procedures offer advantages, such as fewer wound complications, superior cosmesis, and often better visualization. Likewise, intra-abdominal adhesions are markedly reduced following laparoscopic surgery. Adhesions are, however, required for fixation of the Roux-limb to prevent its displacement and to close mesenteric defects that can allow postoperative bowel herniation and subsequent closed-loop obstruction or ischemia.
Management of post-bariatric surgery emergencies is a common practice globally. Due to the popularity and widespread use of bariatric procedures to treat obesity and its comorbidities, emergency physicians and general surgeons will be challenged by the treatment of the short- and long-term complications of bariatric procedures. Although the most immediate complications are treated by bariatric surgeons, late complications are commonly dealt with by General Surgeons.
Despite its overall benefit, there are numerous surgical complications associated with these procedures, including leaks, fistula, abscess, sepsis, internal hernias, abdominal wall hernias, gastric ulcers, dumping syndrome, strictures, bowel obstructions, postoperative bleeding, and gastric and esophageal erosions. As bariatric surgery continues to spread, emergency room physicians must become familiar with the complications of these procedures for early diagnosis and treatment. Non-bariatric surgeons are more likely to be confronted with bariatric emergencies and should have knowledge of the modified anatomy induced by the surgery and its complications in order to achieve early recognition and perform the best procedure. Morbidly obese patients have specific clinical behavior, and physicians who take care of the emergency room should be familiar with these changes.
In this lecture, Dr. Almino Cardoso Ramos, explains the different late complications that may occur in patients operated on for morbid obesity, as well as their symptoms and characteristic signs to be taken into account in the emergency department.