BOSTON — Malnutrition could send obese patients to the emergency department if they have a history of bariatric surgery, Dr. Joshua Broder said at the annual meeting of the American College of Emergency Physicians.
Dr. Broder, of Duke University in Durham, N.C., reviewed the following complications that can arise after different types of bariatric procedures:
▸ Laparoscopic adjustable gastric banding. There have been reports of mechanical problems including breakage, infection, and erosion of the band into the GI tract. Patients often are discharged on the same day or 1 day after undergoing this procedure, he noted.
Early complications include obstruction, edema from intravenous fluids, and proximal migration of the band. Late complications include obstruction and proximal band migration that may cause gastric necrosis and perforation. In cases of gastroesophageal obstruction, deflate the band as soon as possible.
▸ Roux-en-Y gastric bypass. The Roux-en-Y procedure currently is the most common surgery performed to help morbidly obese patients lose weight, Dr. Broder said. It is arguably the most effective because it bypasses a segment of the small bowel and limits the amount of food that can be eaten at a single meal. Early complications from this procedure include anastomosis, found in approximately 2%-11% of these patients.
Long-term complications include systemic nutritional deficiencies because nutrients aren't being absorbed in a section of the small bowel, Dr. Broder said. And the bypassed segment of the small bowel can become obstructed, which produces highly variable symptoms.
▸ Biliopancreatic diversion. The potential for weight loss is high with this type of surgery, but so are the metabolic risks, he noted. All the possible complications of a Roux-en-Y are much more likely, including nutritional deficiencies of fat-soluble vitamins, selenium, and zinc. Studies have shown that about 2% of these patients experience hepatic dysfunction, said Dr. Broder, who disclosed having no financial conflicts.