Complications after Bariatric Surgery
Post Bariatric Intestinal Failure:
 • Severe protein malnutrition after bariatric surgery
 • More common after distal bypass procedures
 • Manifests with edema, muscle wasting, hypoalbuminemia
 • Consider refeeding syndrome before repleting nutrients
 • TPN for treatment, but high complication rate (i.e. infections, thrombosis, hyperglycemia and vitamin deficiencies)
Dumping Syndrome:
 • Rapid delivery of hyperosmolar bolus to the small bowel
 • Gastrointestinal (N/V bloating, abd pain) and vasomotor symptoms (↑HR, flushing, lightheadedness, perspiration) within minutes to 1hr after eating
 • Common after sleeve and RYBG
 • Tx: Small and low carbohydrate meals
Hyperinsulinemic Post-prandial Hypoglycemia:
 • Due to accelerated pouch emptying, excess GLP1 production and excess inuslin release leading to hypoglycemia.
 • Common after RYGB
 • Disorder marked by high variable post prandially glucose (10% asymptomatic)
 • Tx: Frequent and less carbohydrate rich meals
Kidney Stones:
 • Gastric bypass causes increased fat in lumen which saponifies calcium leaving oxalate free
 • ↑ oxalate absorption, calcium binds w/ oxalate in the kidney and forms renal stones
 • Tx: hydration, oral calcium, potassium citrate
Gallstones:
 • Rapid weight loss & bariatric surgery are risk factors for gallstone formation
 • Post operative CCY risk is low
 • ERCP not an option for bypass patients
 • Asymptomatic gallstones in this population should be considered for CCY.
Liver Disease in Bariatric Surgery:
 • Bariatric surgery is typically beneficial for NAFLD, but steatohepatitis and mortality from hepatocellular failure has been reported (occurs w/ long biliopancreatic limbs)
 • Hepatopathy due to microbial proliferation in excluded limb
 • Treatment and prevention of hepatopathy with metronidazole
 • Alcohol misuse and addiction is higher patients after bariatric surgery
 • Compounded malnutrition effects can occur in patients after bariatric surgery with alcohol abuse

by Chuma G. Obineme, MD @TypicallySilent via Emory Gastroenterology and Hepatology @EmoryGastroHep

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