Complications after Bariatric Surgery Post Bariatric Intestinal Failure: • Severe protein malnutrition after bariatric surgery • More common after distal bypass procedures • Manifests with edema, muscle wasting, hypoalbuminemia • Consider refeeding syndrome before repleting nutrients • TPN for treatment, but high complication rate (i.e. infections, thrombosis, hyperglycemia and vitamin deficiencies) Dumping Syndrome: • Rapid delivery of hyperosmolar bolus to the small bowel • Gastrointestinal (N/V bloating, abd pain) and vasomotor symptoms (↑HR, flushing, lightheadedness, perspiration) within minutes to 1hr after eating • Common after sleeve and RYBG • Tx: Small and low carbohydrate meals Hyperinsulinemic Post-prandial Hypoglycemia: • Due to accelerated pouch emptying, excess GLP1 production and excess inuslin release leading to hypoglycemia. • Common after RYGB • Disorder marked by high variable post prandially glucose (10% asymptomatic) • Tx: Frequent and less carbohydrate rich meals Kidney Stones: • Gastric bypass causes increased fat in lumen which saponifies calcium leaving oxalate free • ↑ oxalate absorption, calcium binds w/ oxalate in the kidney and forms renal stones • Tx: hydration, oral calcium, potassium citrate Gallstones: • Rapid weight loss & bariatric surgery are risk factors for gallstone formation • Post operative CCY risk is low • ERCP not an option for bypass patients • Asymptomatic gallstones in this population should be considered for CCY. Liver Disease in Bariatric Surgery: • Bariatric surgery is typically beneficial for NAFLD, but steatohepatitis and mortality from hepatocellular failure has been reported (occurs w/ long biliopancreatic limbs) • Hepatopathy due to microbial proliferation in excluded limb • Treatment and prevention of hepatopathy with metronidazole • Alcohol misuse and addiction is higher patients after bariatric surgery • Compounded malnutrition effects can occur in patients after bariatric surgery with alcohol abuse by Chuma G. Obineme, MD @TypicallySilent via Emory Gastroenterology and Hepatology @EmoryGastroHep #Bariatric #Surgery #Complications #gastric #bypass #gastroenterology #diagnosis #differential
