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Timing and management of bleeding after bariatric surgery
Zaina Naeem1, Panagiotis Volteas1, Alisa Khomutova1
1Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA.
Surgical Endoscopy
|July 3, 2023
Summary
Bleeding after bariatric surgery (sleeve gastrectomy or gastric bypass) differs by procedure type. Sleeve gastrectomy patients face higher reoperation risk, while gastric bypass patients are more likely to have non-operative interventions.
Area of Science:
- Bariatric surgery outcomes
- Gastrointestinal surgery complications
- Surgical quality improvement
Background:
- Post-bariatric surgery bleeding management strategies are not well-defined.
- Understanding reoperation versus non-operative intervention rates is crucial.
Purpose of the Study:
- To compare reoperation and non-operative intervention rates after bleeding in sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).
- To analyze factors influencing the choice between surgical and non-surgical management for post-bariatric bleeding.
Main Methods:
- Utilized the MBSAQIP database (2015-2018) for bleeding events post-SG and RYGB.
- Employed multivariable Fine-Gray and generalized linear regression models to assess intervention risks and counts.
Main Results:
- Identified 2653 patients requiring intervention for bleeding after SG or RYGB.
- Sleeve gastrectomy (SG) was linked to higher reoperation risk; Roux-en-Y gastric bypass (RYGB) to higher non-operative intervention risk.
- Early bleeding increased reoperation risk and decreased non-operative intervention risk, irrespective of the initial procedure.
Conclusions:
- Sleeve gastrectomy patients with bleeding are more prone to reoperation than RYGB patients.
- Roux-en-Y gastric bypass patients with bleeding are more likely to receive non-operative treatment.
- Early post-operative bleeding influences management choices, but the initial intervention type does not affect the total number of subsequent procedures.
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