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Obesity, Bariatric and Metabolic Surgery pp 347–376Cite as

Laparoscopic Roux-en-Y Gastric Bypass: Complications – Diagnosis and Management

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Abstract

Several significant and potentially catastrophic complications can occur after a laparoscopic Roux-en-Y gastric bypass (RYGB). Early complications include anastomotic leaks and hemorrhage, followed by internal herniation with possible small bowel ischemia, fistulation, ulceration, and nutritional and metabolic complications. Other complications include deep venous thrombosis and pulmonary embolism, skin and neurological complications, and cholelithiasis. Bariatric patients may have elusive and nonspecific clinical signs and their weight may restrict the types of imaging investigations available. All these factors may make it difficult to detect complications when they occur. Hence, it is important that the treating surgeon have a high index of suspicion for complications in any bariatric patient, both when postoperative progress does not appear to be following the usual trajectory, and in those presenting with unmanageable pain, fever, or tachycardia. It is also important for the patient to be educated of the potential changes in a normal postoperative course. They should be advised that they, or any other treating clinician, should contact the primary bariatric surgeon in case of any untoward symptoms in the postoperative period, as these may be related to their operation, even if not obvious in the first instance. In the early postoperative stage, if there is any doubt about potential abdominal complications, a diagnostic laparoscopy should be performed without further delay, since these patients can deteriorate very quickly, and abdominal scans may often be unhelpful and/or falsely reassuring.

The complications of RYGB, their incidence, presentation, diagnosis, and management are discussed in this chapter, and in addition, some tips for their prevention are provided.

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Authors and Affiliations

  1. Department of Surgery, Kaiser Permanente, San Francisco, CA, USA

    Susannah M. Rose

  2. Department of Bariatric Surgery, St. Mary’s Hospital, Imperial College, London, UK

    Ahmed R. Ahmed

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  1. Susannah M. Rose
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  2. Ahmed R. Ahmed
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Correspondence to Ahmed R. Ahmed .

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Editors and Affiliations

  1. Homerton University Hospital, London, UK

    Sanjay Agrawal

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  1. Department of General and Bariatric Surgery, Whittington Hospital, London, UK

    Chetan Parmar

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Rose, S.M., Ahmed, A.R. (2023). Laparoscopic Roux-en-Y Gastric Bypass: Complications – Diagnosis and Management. In: Agrawal, S. (eds) Obesity, Bariatric and Metabolic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-60596-4_23

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