Bariatric/metabolic surgery: short- and long-term safety

The increasing incidence of bariatric/metabolic surgery has brought concerns about the short- and long-term safety of this definitive treatment option. Many multicenter, large cohort studies of outcomes after bariatric surgery have been performed worldwide. Due to innovation in surgical methods and postoperative management programs in this field, there is a continuous improvement of outcomes related to safety. Many systemic and surgical complications after bariatric surgery have been reported, and late complications after gastric banding procedure are becoming issues as long-term follow-up studies are being performed. These databases utilize both clinical and administrative data methods. They may report in hospital only 30 or 90 day complication rates. Perioperative mortality in the past has been reported in as many as 1.5 to 2 % of bariatric surgical cases. Most recently this mortality has been reduced to 0.04-0.3 % from registries involving many thousands of patients. Complications are defined variably. Serious complications reportedly occur in 1-4 % of patients. In malabsorptive procedures, nutritional and micronutrient support is important because they frequently cause nutritional and metabolic problems long after surgery. Also, procedure-related complications such as intestinal obstruction and anastomotic stricture should be monitored after gastric bypass. This review refers to such adverse events which can threaten patient safety after bariatric surgery.