Reoperative Surgery for Management of Early Complications After Gastric Bypass

Most papers discussing specifics of reoperative surgery after laparoscopic Roux-en-Y gastric bypass (LRYGB) are over 10 years old.

A retrospective analysis of patients undergoing reoperative surgery within 30 days of LRYGB.

Over a 5-year period, 52 out of 1769 (2.9%) patients underwent reoperation within 30 days of the index LRYGB. The 30-day reoperative surgery rate was 2.5% for primary and 7.1% for revisional LRYGB. The most common indications for reoperation included bleeding (n = 16), followed by bowel obstruction (n = 14), leak (n = 14), and diagnostic exploration for tachycardia and abdominal pain (n = 4). Forty-nine (94%) reoperations were started laparoscopically and six (12%) required conversion to laparotomy. The most common sources of bleeding were the mesenteric vessels (n = 6); the most common cause of obstruction was adhesion (n = 5), and the most common site of leak was the gastric pouch and gastrojejunal anastomosis (n = 9). Twenty (38%) patients developed further complications that led to a third surgery in nine (17%) patients. There were no significant differences as far cause for reoperation noted between patients undergoing primary surgery versus revisional surgery. The 90-day readmission and mortality rates were 29% and zero, respectively.

Type of complications is comparable, and number of complications requiring early surgical reintervention following primary or revisional LRYGB is low. Increasing proportion of patients requiring early reoperation will have undergone a revisional surgery. The majority of these reoperations are accomplished laparoscopically. Bleeding continues to be the most common cause for early reoperation. Although associated with significant morbidity, mortality is rare in this patient population.