Study of Management of Post Bariatric Surgery Complications in El Demerdash Hospital from January 2022 to June 2023
Authors: Marzook Mohamed Abd Elmenaim , Elshayeb Basem , Alsohagy Haytham Mohamed Mohamed Elsayed 
Published: November 2024

Abstract

Background
Obesity is an increasing health concern in the United States and worldwide. According to the World Health Organization, obesity has doubled since 1980. In 2014 alone, more than 1.9 billion adults were classified as overweight, of which 600 million were obese. Durable medical therapy for morbid obesity is limited. As an alternative, many studies have demonstrated the benefits of bariatric surgery in terms of excess weight loss and improvement or resolution of weight-related co- morbid diseases. As of 2013, the most commonly performed laparoscopic bariatric procedures worldwide are Roux-en-Y gastric bypass (RYGB) (45%), sleeve gastrectomy (SG) (37%) and adjustable gastric banding (AGB) (10%).

Objective
To report and analyze the management of complications after bariatric surgery in the bariatric surgery unit in El Demerdash hospital from January 2022 to June 2023.

Methods
This was a retrospective and prospective Study that was conducted at General surgery department, Ain Shams University Hospitals from January 2022 to June 2023 on 25 patients who underwent bariatric surgery and developed postoperative complication. In our study, the ages of the studied cases ranged from 15 to 65 years (mean 34 years).

Results
The results of our present study can be summarized as follows:
•The ages of the studied cases ranged from 15 to 65 years (mean 34 years).
•There were 6 (24.0%) Male cases and 19 (76.0%) Female cases.
•56.0% of cases had Co morbidities, Including nine cases of DM (64.3%), five cases of HTN (35.7%) and three cases of Asthmatic (21.4%).
•The Most common bariatric surgery that was performed for more than half of the cases was LSG, Followed By LRYGB, while the Time of presentation by a complication ranged from 0.07 to 240 months (mean 12 months).
•The Complications that all cases were exposed to, as there were five cases that were exposed to Gallbladder stones (20%), five cases that were exposed to weight regain (20%) and three cases that were exposed to Leakage (12%). The less common complications are internal hernia (8%), MVO (8%), and repeated vomiting (8%). Other complications include chronic constipation (4%), dysphagia and heart burn (4%), infected hematoma (4%), leakage due to perforated anastomotic ulcer (4%), malnutrition (4%), and port site hernia (4%).
•The most common management is laparoscopic cholecystectomy (20%), followed by laparoscopic mini gastric bypass (LMGB) (20%). Other managements include redo open GB (8%), resection anastomosis of gang bowel (4%), endoscopic dilatation (4%), exploration and total enterectomy (4%), herniaplasty with mesh 15 x15 (4%), LGB (4%), pigtail (4%), pigtail at collections and mega stent (4%), reduce the herniated bowels and closure of the defect by vicryl (4%), reduction of gastric sleeve, standard posterior hiatal hernia repair, resection of SG and conversion to LGB (4%), reduction of intesuseption without revision of anastomosis (4%), supplementations (4%), T tube in the perforated anastomotic ulcer (4%), and no intervention (4%).
•According to outcome, (88.0%) Cured and (12%) died

Conclusion
The study highlights that among bariatric surgeries, Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux en Y Gastric Bypass (LRYGB) were the most frequently performed, with LSG being the most common. The study identified gallbladder stones, weight regain, and leakage as the most prevalent complications, predominantly managed through laparoscopic cholecystectomy and laparoscopic mini gastric bypass. Overall, the bariatric surgery cohort exhibited an 88% cure rate but with a 12% mortality rate. Remarkably, patients with comorbidities had a higher cure rate than those without, with diabetes showing the highest cure rate among comorbidities. Notably, gallbladder stones were associated with a lower death rate, whereas mesenteric vessel occlusion (MVO) and malnutrition were linked to higher mortality rates. Our study's findings suggest that bariatric surgery is a safe and effective procedure for weight loss. However, it is important to be aware of the potential complications, and to seek prompt medical attention if any complications occur.