(1) Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School
(2) Department of Medicine, Mount Auburn Hospital, Harvard Medical School
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Obesity is a major health problem worldwide. Gastric bypass surgery is increasingly being used to manage obesity. Roux-en-Y gastric bypass surgery is associated with a number of early and late gastrointestinal complications. This manuscript aims to review the early and late gastrointestinal complications of Roux-en-Y gastric bypass surgery.
Predictors of complications include patient comorbidities: Age > 65, BMI > 50, obstructive sleep apnoea, gastroesophageal reflux disease, history of a thrombotic event, diabetes, hyperlipidaemia, peripheral vascular disease hypertension, renal impairment, arthritis and asthma. Additionally, surgical technique (e.g open vs laparoscopic) and intraoperative complications also predict post-operative complications. Early complications include gastrointestinal bleeding (GIB), anastamotic leaks and small bowel obstruction. Late complications include hernias, intestinal obstruction, marginal ulcers, fistulas, anastamotic strictures, cholelithiasis, intussusception, nutritional deficiencies, and dumping syndrome.
Overall, the complications resulting from Roux-en-Y gastric bypass are usually amenable to endoscopic or surgical treatment. However, early recognition and treatment of these complications are critical to reduce overall morbidity and mortality.