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Complications in Bariatric Surgery (Aftermath and Comorbidities)
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Complications in Bariatric Surgery (Aftermath and Comorbidities)

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (17 May 2023) | Viewed by 11491

Special Issue Editor

Dr. Jerry Dang

E-Mail Website
Guest Editor
Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
Interests: bariatric surgery; metabolic surgery; flexible endoscopic surgery; foregut surgery; obesity; microbiome; minimally invasive surgery; gastrointestinal surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Bariatric surgery is the most effective treatment for severe obesity, diabetes, and metabolic syndrome and is increasingly used worldwide. The procedures employed most frequently are the Roux-en-Y gastric bypass and sleeve gastrectomy; however, biliopancreatic diversion with duodenal switch, one anastomosis gastric bypass, and single-anastomosis duodeno-ileal bypass are used in certain scenarios. Adjustable gastric banding is less commonly used today due to a high rate of complications and need for reoperations.

Although bariatric procedures are generally safe with rare mortality, they are not without complications. These include early complications such as anastomotic leaks, postoperative bleeding, marginal ulcers, and venous thromboembolism. Late complications include internal hernias, stenosis, dumping syndrome, and nutritional deficiencies. Less common complications include gastrogastric fistulas, candy cane syndrome, and nesidioblastosis, which can be difficult to manage.

Due to the high volume of bariatric surgery being performed today, improving the safety of bariatric surgery continues to be a priority. This has led to the development of center accreditation to ensure high standards of care before, during, and after bariatric surgery. In this Special Issue entitled “Complications of Bariatric Surgery”, I would like to focus on presenting both original research and review articles discussing common and rare complications of bariatric surgery with an emphasis on strategies to optimize patient care, procedures, and perioperative care to reduce complications.

Dr. Jerry Dang
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • bariatric surgery
  • severe obesity
  • metabolic syndrome
  • gastric bypass
  • sleeve gastrectomy
  • anastomotic leaks
  • gastrogastric fistulas
  • postoperative complications

Published Papers (5 papers)

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Research

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11 pages, 552 KiB  
Article
Revisional Procedures after Sleeve Gastrectomy for Weight Recurrence or Inadequate Weight Loss: An Analysis of the MBSAQIP Database
by Karl Hage, Juan S. Barajas-Gamboa, Gustavo Romero-Velez, Matthew Allemang, Salvador Navarrete, Ricard Corcelles, John Rodriguez, Omar M. Ghanem, Matthew Kroh and Jerry T. Dang
J. Clin. Med. 2023, 12(18), 5975; https://doi.org/10.3390/jcm12185975 - 15 Sep 2023
Cited by 1 | Viewed by 787
Abstract
Introduction: The safety of conversional bariatric procedures after sleeve gastrectomy (SG) for weight recurrence (WR) or inadequate weight loss (IWL) is debated due to limited evidence. Conversion options include Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileal bypass (SADI), and biliopancreatic diversion with duodenal [...] Read more.
Introduction: The safety of conversional bariatric procedures after sleeve gastrectomy (SG) for weight recurrence (WR) or inadequate weight loss (IWL) is debated due to limited evidence. Conversion options include Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileal bypass (SADI), and biliopancreatic diversion with duodenal switch (BPD-DS). We aimed to compare serious complications and mortality rates between these procedures within 30 days. Methods: Using the 2020 and 2021 MBSAQIP databases, we identified patients who underwent a conversion from SG to RYGB, SADI, or BPD-DS. We performed a multivariable logistic regression to assess predictors of 30-day complications and mortality. Results: Among 7388 patients (77.6% RYGB, 8.7% SADI, 13.7% BPD-DS), those undergoing SADI and BPD-DS had higher preoperative body mass index. Conversion reasons included WR (63.0%) and IWL (37.0%). SADI and BPD-DS patients had longer operative times (p < 0.001) and higher leak rates (p = 0.001). Serious complications, reoperations, readmissions, and 30-day mortality were similar across groups. Conversion procedure type was not an independent predictor of complications. Conclusion: RYGB was the most performed conversional procedure after SG. The study indicated a similar safety profile for revisional RYGB, SADI, and BPD-DS, with comparable 30-day complications and mortality rates. However, SADI and BPD-DS patients had longer operative time and higher leak rates. Full article
(This article belongs to the Special Issue Complications in Bariatric Surgery (Aftermath and Comorbidities))
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11 pages, 256 KiB  
Article
Safety and Efficacy of Metabolic Surgery in Patients with Type 2 Diabetes in the Middle East and North Africa Region: An Analysis of Primary Roux-en-Y Gastric Bypass and Sleeve Gastrectomy Outcomes
by Sami Fares, Juan S. Barajas-Gamboa, Gabriel Díaz del Gobbo, Michael Klingler, Juan Pablo Pantoja, Carlos Abril, Javed Raza, Alfredo D. Guerron, Ricard Corcelles, Matthew Allemang, John Rodriguez and Matthew Kroh
J. Clin. Med. 2023, 12(15), 5077; https://doi.org/10.3390/jcm12155077 - 02 Aug 2023
Viewed by 724
Abstract
Introduction: Type 2 diabetes (T2D) is a chronic medical condition that results in significant health implications and reduced life expectancy. The International Diabetes Federation (IDF) estimated that in 2021, 51.8% of all deaths of people under 60 years old in the Middle East [...] Read more.
Introduction: Type 2 diabetes (T2D) is a chronic medical condition that results in significant health implications and reduced life expectancy. The International Diabetes Federation (IDF) estimated that in 2021, 51.8% of all deaths of people under 60 years old in the Middle East and North Africa (MENA) region were related to diabetes. Bariatric surgery has been demonstrated to be a safe and effective treatment for T2D in different populations worldwide, though few specific data exist on outcomes of procedures in the MENA region. The aim of this study was to compare the safety and postoperative outcomes between patients with and without T2D undergoing primary bariatric surgery at a tertiary referral academic medical center in the United Arab Emirates. Methods: All patients who underwent primary metabolic surgery between September 2015 and July 2020 were retrospectively reviewed from a prospective database. Group 1 included patients with T2D, and Group 2 included patients without T2D. Patients undergoing revisional or correctional operations were excluded. The procedure performed was based on surgeon discretion in discussion with a multidisciplinary team and the patient. Demographics as well as perioperative and postoperative results were examined. Results: Our study included 542 patients, 160 (29.5%) with T2D and 382 (70.5%) with non-T2D. Mean age was 44.5 years (range 16–70) in the T2D group and 33.3 years (range 15–63) in the non-T2D group; median BMI was 41.8 ± 7.3 and 43.2 ± 7.2, respectively. The T2D group was 37.5% male and 62.5% female, and the non-T2D group was 38.7% male and 61.3% female. There were no significant differences in comorbidities. In the T2D group, 45.6% of patients underwent Roux-en-Y gastric bypass and 54.4% sleeve gastrectomy. In the non-TD2 group, 42.7% of patients received Roux-en-Y gastric bypass and 57.3% sleeve gastrectomy. There were no statistically significant differences in postoperative ED visits (21.8% vs. 24.3%, p = 0.21), minor complications within 30 days (4.3% vs. 5.2%, p = 0.67), readmission rates (5.6% vs. 4.9%, p = 0.77), re-operation rates (3.7% vs. 1.5%, p = 0.11), median hospital stay (2.0 days vs. 3.0, p = 0.05), or complications after 30 days (6.2% vs. 11.2%, p = 0.07). There were no deaths either group. Conclusions: In this cohort of patients from the MENA region, bariatric surgery in T2D patients is safe and effective, with perioperative outcomes comparable to those of non-T2D patients. To the best of our knowledge, our postoperative findings, which are the first report in the MENA region, are consistent with studies published in North America and Europe. Full article
(This article belongs to the Special Issue Complications in Bariatric Surgery (Aftermath and Comorbidities))
17 pages, 731 KiB  
Article
Periodontal Therapy in Bariatric Surgery Patients with Periodontitis: Randomized Control Clinical Trial
by Dejana Čolak, Alja Cmok Kučič, Tadeja Pintar and Rok Gašperšič
J. Clin. Med. 2022, 11(22), 6837; https://doi.org/10.3390/jcm11226837 - 19 Nov 2022
Viewed by 1428
Abstract
Background: Bariatric surgery (BS) patients may experience the progression of periodontitis during recovery. We aimed to determine whether non-surgical periodontal therapy before BS improves the periodontal and systemic health parameters after the surgery. Methods: BS candidates with periodontitis were randomized into the test [...] Read more.
Background: Bariatric surgery (BS) patients may experience the progression of periodontitis during recovery. We aimed to determine whether non-surgical periodontal therapy before BS improves the periodontal and systemic health parameters after the surgery. Methods: BS candidates with periodontitis were randomized into the test (TG) and control group (CG). One month before BS (pre-BS), patients in the TG (n = 15) received non-surgical periodontal therapy, while patients in the CG (n = 15) received only mechanical plaque removal. Patients were re-examined 3 and 6 months after BS. Differences between the TG and CG in clinical periodontal parameters, systemic health-related serum biomarkers, parameters of obesity, and prevalence of obesity-related diseases were evaluated. Results: From the 30 included patients, 26 were re-examined at 3 months and 20 patients at 6 months. Periodontal parameters bleeding on probing (p = 0.015), periodontal pocket dept (PPD, p = 0.0015), % PPD > 4 mm (p < 0.001), and full-mouth plaque levels (p = 0.002) were lower in the TG than in the CG at 6 months after BS. There is a general improvement in systemic health after BS without significant differences (p > 0.05) between the TG and CG at the 6-month follow-up. The TG shows a tendency for improvement in metabolic syndrome components at the 6-month follow-up compared to pre-BS (p < 0.05). Conclusions: Non-surgical periodontal therapy in periodontitis patients before the BS may improve periodontal health 3 and 6 months after the surgery. The possible benefits of periodontal therapy on the overall health of BS patients should be further explored. Full article
(This article belongs to the Special Issue Complications in Bariatric Surgery (Aftermath and Comorbidities))
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Review

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12 pages, 293 KiB  
Review
Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management
by Marita Salame, Noura Jawhar, Amanda Belluzzi, Mohammad Al-Kordi, Andrew C. Storm, Barham K. Abu Dayyeh and Omar M. Ghanem
J. Clin. Med. 2023, 12(13), 4336; https://doi.org/10.3390/jcm12134336 - 28 Jun 2023
Cited by 5 | Viewed by 6647
Abstract
Marginal ulcer (MU) is a potential complication following Roux-en-Y gastric bypass (RYGB), with a mean prevalence of 4.6%. Early identification and prompt intervention are crucial to mitigating further complications. The pathophysiology of MU is complex and involves multiple factors, including smoking, Helicobacter pylori [...] Read more.
Marginal ulcer (MU) is a potential complication following Roux-en-Y gastric bypass (RYGB), with a mean prevalence of 4.6%. Early identification and prompt intervention are crucial to mitigating further complications. The pathophysiology of MU is complex and involves multiple factors, including smoking, Helicobacter pylori infection, non-steroidal anti-inflammatory drug (NSAID) use, and larger pouch size. Patients with MU may experience acute or chronic abdominal pain. Rarely, they may present with a complication from the ulceration, such as bleeding, perforation, or strictures. Following diagnosis by endoscopy, management of MU typically involves modification of risk factors and medical therapy focused on proton pump inhibitors. In case of complicated ulcers, surgical intervention is often required for the repair of the perforation or resection of the stricture. For recurrent or recalcitrant ulcers, endoscopic coverage of the ulcer bed, resection of the anastomosis, and abdominal or thoracoscopic truncal vagotomy may be considered. This review aims at providing an overview of the etiology, diagnosis, and management of MU after RYGB. Full article
(This article belongs to the Special Issue Complications in Bariatric Surgery (Aftermath and Comorbidities))

Other

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18 pages, 7465 KiB  
Case Report
“Orphaned” Stomach—An Infrequent Complication of Gastric Bypass Revision
by Dimitrios N. Varvoglis, Manuel Sanchez-Casalongue, Todd H. Baron and Timothy M. Farrell
J. Clin. Med. 2022, 11(24), 7487; https://doi.org/10.3390/jcm11247487 - 17 Dec 2022
Viewed by 1148
Abstract
While generally safe, bariatric operations have a variety of possible complications. We present an uncommon complication after gastric bypass revision, namely the creation of an “orphaned” segment of remnant stomach that was left inadvertently in discontinuity, leading to recurrent intra-abdominal abscesses. Sinogram ultimately [...] Read more.
While generally safe, bariatric operations have a variety of possible complications. We present an uncommon complication after gastric bypass revision, namely the creation of an “orphaned” segment of remnant stomach that was left inadvertently in discontinuity, leading to recurrent intra-abdominal abscesses. Sinogram ultimately proved the diagnosis, and the issue was successfully treated using a combination of surgical and endoscopic methods to control the abscess and to allow internal drainage. Full article
(This article belongs to the Special Issue Complications in Bariatric Surgery (Aftermath and Comorbidities))
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