Bariatric Emergencies Management Strategies Are Developed for General Surgeons

Altieri MS, Rogers A, Afaneh C, et al. Bariatric Emergencies for the General Surgeon. Surg Obes Relat Dis. 2023;19(5):421-433.

Because the number of patients undergoing bariatric surgical procedures is increasing, patients with complications may present to emergency departments when no bariatric surgeon is available. General surgeons will be asked to manage these patients and will benefit from evidence-based recommendations for management of common postoperative complications.

This article provided supporting data and clearly described recommendations for management of anastomotic leak, marginal ulcer, gastric band slippage, bowel obstruction, and biliary disease. The authors noted that anastomotic leaks are managed with aggressive resuscitation, imaging for localization of the leak, drainage of associated abscess or fluid collection, nutritional support, and surgical repair of the leak in selected patients. Marginal ulcers do not often require surgical intervention unless perforation or bleeding occur.

Gastric band slippage is managed with percutaneous drainage of fluid collections and surgical removal of the band if symptoms persist. Intestinal obstruction may be caused by adhesions, intussusception, or internal hernia.

CT imaging is useful for confirming the diagnosis. Lysis of adhesions, repair of internal hernia, and revision of intestinal anastomosis are surgical interventions that may be needed for intestinal obstruction.

Surgeons are encouraged to review the full content of this article.