Bariatric Surgery Complications in the ED: Diagnosis and Management
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Emergency Department Management of Patients With Complications of Bariatric Surgery

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Table of Contents
 
About This Issue

Bariatric surgery has shown evidence of being a means of achieving sustainable weight loss, along with improvement in the comorbidities associated with obesity, such as hypertension, diabetes, and dyslipidemia. Though relatively safe, these patients do frequently present to the ED with complications, and proper management depends on emergency clinicians’ swift recognition and treatment.

What are the most common types of surgical procedures? Which ones have the highest likelihood of complications?

What is the difference between restrictive and malabsorptive procedures and how does this affect the type of complications seen?

Each procedure has common “early” and “late” complications; how can you quickly tell what the complication might be, based on the time post surgery?

Which laboratory tests can point to obstruction, gallbladder disease, or sepsis?

What are the conditions plain x-rays can show? What complications are evident on upper GI series with oral contrast?

CT imaging can show hernias, leaks, perforations, and erosions; what are the signs to look out for?

When should you admit, and when does the bariatric surgeon need to be consulted?

Table of Contents
  1. Abstract
  2. Case Presentations
  3. Introduction
  4. Critical Appraisal of the Literature
  5. Epidemiology and Etiology
    1. Overview of Bariatric Procedures
      1. Laparoscopic Gastric Sleeve (Sleeve Gastrectomy)
      2. Laparoscopic Adjustable Gastric Banding
      3. Roux-en-Y Gastric Bypass
      4. Other Bariatric Procedures
  6. Pathophysiology
    1. Nonsurgical/General Complications
    2. Surgical Complications
      1. Nutritional Deficiencies
      2. Complications of Sleeve Gastrectomy
        • Early Complications of Sleeve Gastrectomy
        • Late Complications of Sleeve Gastrectomy
      3. Complications of Roux-en-Y Gastric Bypass
        • Early Complications of Roux-en-Y Gastric Bypass
        • Late Complications of Roux-en-Y Gastric Bypass
      4. Laparoscopic Adjustable Gastric Band Complications
        • Early Complications of Adjustable Gastric Band Surgery
        • Late Complications of Laparoscopic Adjustable Gastric Band Surgery
      5. Rare Complications
  7. Differential Diagnosis
  8. Prehospital Care
  9. Emergency Department Evaluation
    1. Initial Stabilization
      1. Airway Management
      2. Breathing
      3. Circulation
    2. History
    3. Physical Examination
  10. Diagnostic Studies
    1. Laboratory and Diagnostic Testing
    2. Imaging Studies
      1. Plain Radiographs
      2. Upper Gastrointestinal Series With Oral Contrast
      3. Computed Tomography
      4. Endoscopy
      5. Ultrasound
  11. Treatment
  12. Special Populations
    1. Pediatric Patients
    2. Considerations for Women of Childbearing Age/Pregnancy
  13. Controversies and Cutting Edge
    1. Endoscopic Procedures
    2. Aspiration Techniques
  14. Disposition
    1. Admission
    2. Discharge
  15. Summary
  16. Risk Management Pitfalls in Managing Patients With Bariatric Surgery Complications
  17. Case Conclusions
  18. Clinical Pathway for Emergency Department Management of Patients With Bariatric Surgery Complications
  19. Tables and Figures
    1. Table 1. Indications for Bariatric Surgery Procedures
    2. Table 2. Complications of Bariatric Procedures
    3. Table 3. Treatment of Bariatric Surgery Complications
    4. Table 4. Indications for Bariatric Surgery Procedures in Adolescents
    5. Figure 1. Gastric Sleeve
    6. Figure 2. Adjustable Gastric Band
    7. Figure 3. Roux-en-Y Gastric Bypass
    8. Figure 4. Vertical Banded Gastroplasty
    9. Figure 5. Biliopancreatic Diversion
    10. Figure 6. Potential Spaces for Internal Herniation Following a Retrocolic Roux-en-Y Gastric Bypass
    11. Figure 7. Normally Positioned Gastric Band on X-Ray
    12. Figure 8. Slipped Gastric Band on X-Ray
    13. Figure 9. Obstruction of the Biliopancreatic Limb Following Roux-en-Y Gastric Bypass
    14. Figure 10. Gastro-Jejunal Anastomotic Leak Following Open Roux-en-Y Gastric Bypass
    15. Figure 11. CT Image of the Mesenteric Swirl Sign With a Small-Bowel Obstruction
  20. References

 

Abstract

As bariatric procedures have become more common, more of these patients present to the emergency department postoperatively. The most common complaints in these patients are abdominal pain, nausea, and vomiting, though each of the surgical procedures will present with specific complications, and management will vary according to the surgical procedure performed. Computed tomography is often the primary imaging modality, though it has it limits, and plain film imaging is appropriate in some cases. This review presents an overview of the various bariatric procedures, highlighting the potential complications of each, both surgical and nonsurgical, and provides evidence-based recommendations regarding patient management and disposition.

 

Case Presentations

You are in the middle of a busy shift, during which you have seen several patients with abdominal pain, vomiting, and diarrhea. Your next patient is a 54-year-old woman who also presents for abdominal pain. She is 2 weeks out from a Roux-en-Y gastric bypass procedure and reports that her pain is diffuse and severe. She is ill-appearing, with vital signs notable for tachycardia, hypotension, and a low-grade fever. Her abdomen is diffusely tender and peritonitic. You immediately initiate resuscitation with IV fluids and broad-spectrum antibiotics and obtain laboratory studies and cultures. You have limited experience with such patients, but you realize that she will require advanced imaging to determine the diagnosis. You wonder what diagnostic tests to order and what treatment, if any, you should start…

You are later called to the bedside of another patient who presents for nausea and vomiting. He is a 38-year-old man who is 2 weeks out from the placement of a laparoscopic adjustable gastric band. He reports that he had an acute onset of nausea and vomiting this evening. He is actively vomiting on presentation and complains of diffuse abdominal pain, but is hemodynamically stable. While attempting to contact his surgeon, you wonder what the best imaging modality is to make the diagnosis….

Your final patient of the evening is a 63-year-old woman who presents for chest and upper abdominal pain as well as shortness of breath. She was discharged home 2 days ago after undergoing a gastric sleeve procedure. She appears uncomfortable and is tachycardic and hypoxic on evaluation. In the process of completing your evaluation, you wonder how this presentation could be related to her bariatric procedure . . .

 

Introduction

Obesity, defined as a body mass index (BMI) of > 30 kg/m2, is a significant public health concern because it affects a large proportion of the population, both in the United States and worldwide. It is associated with an increased risk of developing chronic diseases such as type 2 diabetes mellitus, hypertension, and hyperlipidemia. This rise in the prevalence of obesity and its related comorbidities has resulted in a concurrent increase in the number of bariatric procedures performed, because this is the only (evidence-based) means of achieving sustainable weight loss.1,2

Bariatric procedures can be classified as restrictive, malabsorptive, or a combination of both. The 3 most commonly performed procedures in the United States are: (1) laparoscopic sleeve gastrectomy, (2) the Roux-en-Y gastric bypass (performed either laparoscopically or open), and (3) laparoscopic adjustable gastric banding. Each has specific complications that are due largely to postoperative anatomic changes.

Many of these patients will present to the emergency department (ED) postoperatively. A retrospective study looking at 38,776 patients over a 3-year period showed a 30-day unplanned ED utilization rate of 11.3%, with a 30-day hospital readmission rate of 5.3%.3 Similar trends have been noted in other studies. One study showed that approximately 14.6% of patients had a postoperative ED visit (not resulting in an admission) in the 2 years reviewed.4 In another study, 31.1% of patients had an ED admission following laparoscopic Roux-en-Y gastric bypass surgery, with most presenting within 1 year of the procedure.5 Other studies have estimated that up to 25% of these patients will require admission within the first 2 years of the procedure, with a 30-day admission rate of around 5%.6 Many of the patients described in these studies had multiple ED/hospital visits, generally for abdominal pain, nausea, vomiting, and dehydration.4,5,7 This issue of Emergency Medicine Practice reviews common ED presentations of patients with postoperative bariatric surgery complications, with recommendations on imaging and management, based on the type of surgery performed.

 

Critical Appraisal of the Literature

A literature search was performed on PubMed, using the search terms bariatric, emergency, diagnosis, management, and complications. The reference section of each article was reviewed for additional articles. A search was also performed using the Cochrane Database of Systematic Reviews and Ovid MEDLINE®, but yielded very limited information. The American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines were reviewed. These searches highlighted the fact that the bulk of available research on complications of bariatric procedures is primarily from the surgical literature, with limited studies in the emergency medicine sphere. In addition, many of the available articles were review articles, retrospective cohort studies, or meta-analyses, with very few prospective randomized controlled trials.

 

Risk Management Pitfalls in Managing Patients With Bariatric Surgery Complications

5. “I thought he was tachycardic because he was in pain, so I discharged him home when his vital signs normalized after pain control.”

Tachycardia and tachypnea may be the initial signs of significant intra-abdominal pathology (such as anastomotic leaks) in postoperative bariatric patients, so close attention should be paid to all vital signs. Both can also be seen in patients with pulmonary emboli, which are an important cause of morbidity and mortality in these patients.

6. “The abdominal examination was benign, so I didn’t think she needed a CT.”

Findings on abdominal examination may be subtle in bariatric patients due to the modified anatomy and the amount of adipose tissue, so a benign examination may not be indicative of a lack of significant pathology.

10. “I couldn’t figure out why she kept coming back for persistent diarrhea.”

Dumping syndrome results from a high osmotic load in gastric bypass patients, which causes diarrhea. Patients should be cautioned about dietary modifications to prevent this from occurring.

 

Tables and Figures

Table 1. Indications for Bariatric Surgery Procedures

 

References

Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study is included in bold type following the references, where available. In addition, the most informative references cited in this paper, as determined by the author, are highlighted.

  1. Altieri MS, Wright B, Peredo A, et al. Common weight loss procedures and their complications. Am J Emerg Med. 2018;36(3):475-479. (Review article)
  2. Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014(8):CD003641. (Cochrane review; 22 trials)
  3. Telem DA, Yang J, Altieri M, et al. Rates and risk factors for unplanned emergency department utilization and hospital readmission following bariatric surgery. Ann Surg. 2016;263(5):956-960. (Retrospective study; 38,776 patients)
  4. Macht R, George J, Ameli O, et al. Factors associated with bariatric postoperative emergency department visits. Surg Obes Relat Dis. 2016;12(10):1826-1831. (Retrospective study; 36,673 patients)
  5. Cho M, Kaidar-Person O, Szomstein S, et al. Emergency room visits after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Obes Relat Dis. 2008;4(2):104-109. (Retrospective study; 733 patients)
  6. Telem DA, Talamini M, Gesten F, et al. Hospital admissions greater than 30 days following bariatric surgery: patient and procedure matter. Surg Endosc. 2015;29(6):1310-1315. (Retrospective study; 22,139 patients)
  7. Kellogg TA, Swan T, Leslie DA, et al. Patterns of readmission and reoperation within 90 days after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5(4):416-423. (Retrospective study; 1222 patients)
  8. Hales CM, Carroll MD, Fryar CD, et al. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief, No. 288. Hyattsville, MD: National Center for Health Statistics, 2017. (Government report)
  9. Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int J Obes (Lond). 2013;37(6):889-891. (National report/survey)
  10. Nguyen DM, El-Serag HB. The epidemiology of obesity. Gastroenterol Clin North Am. 2010;39(1):1-7. (Review of national surveys)
  11. Pham S, Gancel A, Scotte M, et al. Comparison of the effectiveness of four bariatric surgery procedures in obese patients with type 2 diabetes: a retrospective study. J Obes. 2014;2014:638203. (Retrospective study; 970 patients)
  12. Yska JP, van Roon EN, de Boer A, et al. Remission of type 2 diabetes mellitus in patients after different types of bariatric surgery: a population-based cohort study in the United Kingdom. JAMA Surg. 2015;150(12):1126-1133. (Retrospective cohort study; 2978 patients)
  13. Poirier P, Cornier MA, Mazzone T, et al. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation. 2011;123(15):1683-1701. (Position paper)
  14. Shimada YJ, Tsugawa Y, Iso H, et al. Association of bariatric surgery with risk of acute care use for hypertension-related disease in obese adults: population-based self-controlled case series study. BMC Med. 2017;15(1):161. (Population-based case series study; 980 patients)
  15. Shimada YJ, Tsugawa Y, Brown DF, et al. Bariatric surgery and emergency department visits and hospitalizations for heart failure exacerbation: population-based, self-controlled series. J Am Coll Cardiol. 2016;67(8):895-903. (Population-based case series study; 524 patients)
  16. Booth H, Khan O, Prevost T, et al. Incidence of type 2 diabetes after bariatric surgery: population-based matched cohort study. Lancet Diabetes Endocrinol. 2014;2(12):963-968. (Retrospective cohort study; 2167 patients)
  17. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017;27(9):2279-2289. (IFSO survey; 56 national society responders)
  18. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21 Suppl 1:S1-S27. (Society practice guidelines)
  19. Caravatto PP, Petry T, Cohen R. Changing guidelines for metabolic surgery: now it’s the time! Curr Atheroscler Rep. 2016;18(8):47. (Review article)
  20. Phillips BT, Shikora SA. The history of metabolic and bariatric surgery: development of standards for patient safety and efficacy. Metabolism. 2018;79:97-107. (Review article)
  21. Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275-287. (Meta-analysis; 164 studies)
  22. Kassir R, Debs T, Blanc P, et al. Complications of bariatric surgery: presentation and emergency management. Int J Surg. 2016;27:77-81. (Review article)
  23. Omalu BI, Ives DG, Buhari AM, et al. Death rates and causes of death after bariatric surgery for Pennsylvania residents, 1995 to 2004. Arch Surg. 2007;142(10):923-928. (Retrospective study; 16,683 operations, 440 deaths)
  24. American Society for Metabolic and Bariatric Surgery: estimate of bariatric surgery numbers, 2011–2017. Accessed June 10, 2019. (ASMBS research)
  25. American Society for Metabolic and Bariatric Surgery: bariatric surgery procedures. Accessed June 10, 2019. (ASMBS website)
  26. Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247(3):401-407. (Prospective randomized controlled trial; 32 patients)
  27. Zellmer JD, Mathiason MA, Kallies KJ, et al. Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg. 2014;208(6):903-910. (Meta-analysis; 61 articles, 15,722 patients)
  28. Alvarenga ES, Lo Menzo E, Szomstein S, et al. Safety and efficacy of 1020 consecutive laparoscopic sleeve gastrectomies performed as a primary treatment modality for morbid obesity. A single-center experience from the metabolic and bariatric surgical accreditation quality and improvement program. Surg Endosc. 2016;30(7):2673-2678. (Retrospective review; 1020 patients)
  29. Ali M, El Chaar M, Ghiassi S, et al. American Society for Metabolic and Bariatric Surgery updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2017;13(10):1652-1657. (Society practice guidelines)
  30. Contival N, Menahem B, Gautier T, et al. Guiding the non-bariatric surgeon through complications of bariatric surgery. J Visc Surg. 2018;155(1):27-40. (Review article)
  31. Patel S, Eckstein J, Acholonu E, et al. Reasons and outcomes of laparoscopic revisional surgery after laparoscopic adjustable gastric banding for morbid obesity. Surg Obes Relat Dis. 2010;6(4):391-398. (Retrospective review; 343 patients)
  32. Altieri MS, Yang J, Telem DA, et al. Lap band outcomes from 19,221 patients across centers and over a decade within the state of New York. Surg Endosc. 2016;30(5):1725-1732. (Retrospective review; 19,221 patients)
  33. Lewis KD, Takenaka KY, Luber SD. Acute abdominal pain in the bariatric surgery patient. Emerg Med Clin North Am. 2016;34(2):387-407. (Review article)
  34. Ellison SR, Ellison SD. Bariatric surgery: a review of the available procedures and complications for the emergency physician. J Emerg Med. 2008;34(1):21-32. (Review article)
  35. Edwards ED, Jacob BP, Gagner M, et al. Presentation and management of common post-weight loss surgery problems in the emergency department. Ann Emerg Med. 2006;47(2):160-166. (Review article)
  36. Baltieri L, Peixoto-Souza FS, Rasera-Junior I, et al. Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery. Braz J Anesthesiol. 2016;66(6):577-582. (Retrospective review; 407 patients)
  37. Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003;138(9):957-961. (Retrospective review/meta-analsysis; 3464 patients)
  38. Melinek J, Livingston E, Cortina G, et al. Autopsy findings following gastric bypass surgery for morbid obesity. Arch Pathol Lab Med. 2002;126(9):1091-1095. (Retrospective study; 10 patients)
  39. Bhatti JA, Nathens AB, Thiruchelvam D, et al. Self-harm emergencies after bariatric surgery: a population-based cohort study. JAMA Surg. 2016;151(3):226-232. (Population-based longitunal cohort analysis; 8815 patients)
  40. Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient, 2016 update: micronutrients. Surg Obes Relat Dis. 2017;13(5):727-741. (Society practice guidelines)
  41. Stroh C, Meyer F, Manger T. Beriberi, a severe complication after metabolic surgery - review of the literature. Obes Facts. 2014;7(4):246-252. (Systematic review; 255 patients)
  42. Armstrong-Javors A, Pratt J, Kharasch S. Wernicke encephalopathy in adolescents after bariatric surgery: case report and review. Pediatrics. 2016;138(6). (Case report and review)
  43. Di Lorenzo N, Lorenzo M, Furbetta F, et al. Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients. Surg Endosc. 2013;27(4):1151-1157. (Retrospective study; 177 patients)
  44. Biagini J, Karam L. Ten years experience with laparoscopic adjustable gastric banding. Obes Surg. 2008;18(5):573-577. (Retrospective study; 591 patients)
  45. Abu-Abeid S, Keidar A, Gavert N, et al. The clinical spectrum of band erosion following laparoscopic adjustable silicone gastric banding for morbid obesity. Surg Endosc. 2003;17(6):861-863. (Retrospective study; 1496 patients)
  46. Csendes A, Braghetto I, Leon P, et al. Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity. J Gastrointest Surg. 2010;14(9):1343-1348. (Retrospective review; 343 patients)
  47. Stenard F, Iannelli A. Laparoscopic sleeve gastrectomy and gastroesophageal reflux. World J Gastroenterol. 2015;21(36):10348-10357. (Review article)
  48. Jacobsen HJ, Nergard BJ, Leifsson BG, et al. Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass. Br J Surg. 2014;101(4):417-423. (Prospective study; 6030 patients)
  49. Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract. 2005;20(5):517-525. (Review article)
  50. Greenstein AJ, O’Rourke RW. Abdominal pain after gastric bypass: suspects and solutions. Am J Surg. 2011;201(6):819-827. (Review article)
  51. Chousleb E, Chousleb A. Management of post-bariatric surgery emergencies. J Gastrointest Surg. 2017;21(11):1946-1953. (Review article)
  52. Sverden E, Mattsson F, Sonden A, et al. Risk factors for marginal ulcer after gastric bypass surgery for obesity: A population-based cohort study. Ann Surg. 2016;263(4):733-737. (Population-based cohort study; 20,294 patients)
  53. Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol. 2006;186(3):703-717. (Review article)
  54. Bradley JF 3rd, Ross SW, Christmas AB, et al. Complications of bariatric surgery: the acute care surgeon’s experience. Am J Surg. 2015;210(3):456-461. (Retrospective review; 33 patients)
  55. Coupaye M, Castel B, Sami O, et al. Comparison of the incidence of cholelithiasis after sleeve gastrectomy and Roux-en-Y gastric bypass in obese patients: a prospective study. Surg Obes Relat Dis. 2015;11(4):779-784. (Prospective study; 160 patients)
  56. Amstutz S, Michel JM, Kopp S, et al. Potential benefits of prophylactic cholecystectomy in patients undergoing bariatric bypass surgery. Obes Surg. 2015;25(11):2054-2060. (Retrospective study; 117 patients)
  57. Bhatti UH, Duffy AJ, Roberts KE, et al. Nephrolithiasis after bariatric surgery: a review of pathophysiologic mechanisms and procedural risk. Int J Surg. 2016;36(Pt D):618-623. (Review article)
  58. Park AM, Storm DW, Fulmer BR, et al. A prospective study of risk factors for nephrolithiasis after Roux-en-Y gastric bypass surgery. J Urol. 2009;182(5):2334-2339. (Prospective study; 45 patients)
  59. Chakravartty S, Sarma DR, Patel AG. Rhabdomyolysis in bariatric surgery: a systematic review. Obes Surg. 2013;23(8):1333-1340. (Systematic review)
  60. American Society for Metabolic and Bariatric Surgery: medical tourism. Accessed June 10, 2019. (ASMBS website)
  61. Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240-245. (Retrospective study; 2834 patients)
  62. Levine MS, Carucci LR. Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology. 2014;270(2):327-341. (Review article)
  63. Karila-Cohen P, Cuccioli F, Tammaro P, et al. Contribution of computed tomographic imaging to the management of acute abdominal pain after gastric bypass: correlation between radiological and surgical findings. Obes Surg. 2017;27(8):1961-1972. (Retrospective review; 64 patients)
  64. Iannuccilli JD, Grand D, Murphy BL, et al. Sensitivity and specificity of eight CT signs in the preoperative diagnosis of internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Clin Radiol. 2009;64(4):373-380. (Retrospective, blinded study; 19 patients)
  65. Goudsmedt F, Deylgat B, Coenegrachts K, et al. Internal hernia after laparoscopic Roux-en-Y gastric bypass: a correlation between radiological and operative findings. Obes Surg. 2015;25(4):622-627. (Retrospective review; 7328 patients)
  66. Altieri MS, Pryor AD, Telem DA, et al. Algorithmic approach to utilization of CT scans for detection of internal hernia in the gastric bypass patient. Surg Obes Relat Dis. 2015;11(6):1207-1211. (Retrospective review; 52 patients)
  67. Joo MK. Endoscopic approach for major complications of bariatric surgery. Clin Endosc. 2017;50(1):31-41. (Review article)
  68. Freeman L, Brown WA, Korin A, et al. An approach to the assessment and management of the laparoscopic adjustable gastric band patient in the emergency department. Emerg Med Australas. 2011;23(2):186-194. (Retrospective review; 41 patients)
  69. Zwintscher NP, Azarow KS, Horton JD, et al. The increasing incidence of adolescent bariatric surgery. J Pediatr Surg. 2013;48(12):2401-2407. (Retrospective review; 1615 patients)
  70. Michalsky M, Reichard K, Inge T, et al. ASMBS pediatric committee best practice guidelines. Surg Obes Relat Dis. 2012;8(1):1-7. (Society practice guidelines)
  71. Pratt JS, Lenders CM, Dionne EA, et al. Best practice updates for pediatric/adolescent weight loss surgery. Obesity (Silver Spring). 2009;17(5):901-910. (Systematic review and practice guidelines)
  72. Kelleher DC, Merrill CT, Cottrell LT, et al. Recent national trends in the use of adolescent inpatient bariatric surgery: 2000 through 2009. JAMA Pediatr. 2013;167(2):126-132. (Retrospective cross-sectional study)
  73. Iqbal CW, Kumar S, Iqbal AD, et al. Perspectives on pediatric bariatric surgery: identifying barriers to referral. Surg Obes Relat Dis. 2009;5(1):88-93. (Survey; 61 physicians)
  74. Lennerz BS, Wabitsch M, Lippert H, et al. Bariatric surgery in adolescents and young adults--safety and effectiveness in a cohort of 345 patients. Int J Obes (Lond). 2014;38(3):334-340. (Prospective longitudinal study; 345 patients)
  75. Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374(2):113-123. (Prospective study; 242 patients)
  76. Inge TH, Jenkins TM, Xanthakos SA, et al. Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis. Lancet Diabetes Endocrinol. 2017;5(3):165-173. (Retrospective study; 55 patients)
  77. Loux TJ, Haricharan RN, Clements RH, et al. Health-related quality of life before and after bariatric surgery in adolescents. J Pediatr Surg. 2008;43(7):1275-1279. (Survey; 9 gastric bypass patients)
  78. Klebanoff MJ, Chhatwal J, Nudel JD, et al. Cost-effectiveness of bariatric surgery in adolescents with obesity. JAMA Surg. 2017;152(2):136-141. (Cost-effectiveness analysis; 288 patients)
  79. Vilallonga R, Himpens J, van de Vrande S. Long-term (7 years) follow-up of Roux-en-Y gastric bypass on obese adolescent patients (<18 years). Obes Facts. 2016;9(2):91-100. (Retrospective study; 28 patients)
  80. Parent B, Martopullo I, Weiss NS, et al. Bariatric surgery in women of childbearing age, timing between an operation and birth, and associated perinatal complications. JAMA Surg. 2017;152(2):128-135. (Population-based retrospective cohort study; 10,296 patients)
  81. Galazis N, Docheva N, Simillis C, et al. Maternal and neonatal outcomes in women undergoing bariatric surgery: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2014;181:45-53. (Systematic review; 17 studies)
  82. Carreau AM, Nadeau M, Marceau S, et al. Pregnancy after bariatric surgery: balancing risks and benefits. Can J Diabetes. 2017;41(4):432-438. (Systematic review)
  83. Burke AE, Bennett WL, Jamshidi RM, et al. Reduced incidence of gestational diabetes with bariatric surgery. J Am Coll Surg. 2010;211(2):169-175. (Retrospective study; 700 patients)
  84. Kjaer MM, Lauenborg J, Breum BM, et al. The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study. Am J Obstet Gynecol. 2013;208(6):464. (Register-based matched cohort study; 1616 patients)
  85. ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol. 2009;113(6):1405-1413. (Society practice guideline)
  86. Apovian CM, Baker C, Ludwig DS, et al. Best practice guidelines in pediatric/adolescent weight loss surgery. Obes Res. 2005;13(2):274-282. (Systematic review; 8 case series)
  87. Kjaer MM, Nilas L. Timing of pregnancy after gastric bypass-a national register-based cohort study. Obes Surg. 2013;23(8):1281-1285. (National register-based cohort study; 286 patients)
  88. Ali MR, Moustarah F, Kim JJ. American Society for Metabolic and Bariatric Surgery position statement on intragastric balloon therapy endorsed by the Society of American Gastrointestinal and Endoscopic Surgeons. Surg Obes Relat Dis. 2016;12(3):462-467. (Society practice guidelines)
  89. American Society for Metabolic and Bariatric Surgery position statement on emergency care of patients with complications related to bariatric surgery. Surg Obes Relat Dis. 2010;6(2):115-117. (Society practice guidelines)
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Publication Information
Authors

Adedamola Ogunniyi, MD

Peer Reviewed By

May Li, MD; Samuel D. Luber, MD, MPH, FACEP

Publication Date

July 1, 2019

CME Expiration Date

August 1, 2022

Pub Med ID: 31233303

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