Bariatric surgery: ‘Invaluable tool’ for complications of obesity
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Bariatric surgery can be an invaluable tool for managing the myriad complications of obesity such as diabetes, fatty liver disease, hypertension, hyperlipidemia, gastroesophageal reflux and obstructive sleep apnea.
In addition, it has been associated with a reduction in mortality.
Like any tool, however, complications can occur and these must be recognized and managed. In this month’s cover story, some of these gastrointestinal complications are reviewed, along with the novel endoscopic techniques that can be used to manage them.
Like any tool, however, complications can occur and these must be recognized and managed. In this month’s cover story, some of these gastrointestinal complications are reviewed, along with the novel endoscopic techniques that can be used to manage them.
My colleague Andrew C. Storm, MD, highlights the issue of marginal ulcers, which are multifactorial in origin. He emphasizes the need for smoking cessation, ensuring that proton pump inhibitors can be absorbed (sometimes by opening the capsule), ruling out a gastro-gastric fistula from the excluded gastric remnant, removal of sutures and novel endoscopic techniques to heal the ulcer.
Barham K. Abu Dayyeh, MD, MPH, notes the problem of stenosis and strictures – some of which can be managed with judicious use of endoscopic balloon dilation.
Manoel Galvao Neto, MD, MSC, FASBMS, FASGE, from Sao Paolo, emphasizes the utility of endoscopic procedures to manage postoperative fistulas and leaks, thus avoiding a surgical revision that can be associated with increased morbidity.
Pichamol Jirapinyo, MD, MPH, ABOM, a bariatric endoscopist from Brigham and Women’s Hospital, tells us that even weight regain following bariatric surgery can be managed endoscopically, either by reducing the diameter of the gastric outlet or using endoscopic suturing techniques to tighten up the gastric sleeve.
Finally, Erik B. Wilson, MD, from Houston, notes that gastroesophageal reflux can occur after such surgery, but often it is bilious and not acidic. This can occur more commonly with a sleeve than with a Roux-en-Y gastric bypass.
We must be attuned to other complications as well. Cholelithiasis, nephrolithiasis, dumping syndrome and malnutrition can all occur. Some patients – often those with underlying mental health issues – may be more susceptible after surgery to anxiety, depression, substance abuse disorders (especially alcohol) and even increased suicide risk. It is for these reasons that patients should undergo a thorough psychological evaluation prior to surgery.
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