Gastrointestinal Complications of Obesity Surgery

John E. Pandolfino, MD; Brintha Krishnamoorthy, BS; Thomas J. Lee, MD

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In This Article

Introduction

Obesity has achieved epidemic proportions and is currently a national health crisis in the United States. Twenty-seven percent of the American population is obese (body mass index [BMI] ≥ 30 kg/m2), resulting in approximately 300,000 deaths annually and $100 billion per year in direct and indirect costs (17% of total healthcare costs).[1,2,3] Obese individuals are at increased risk for hypertension, diabetes, pulmonary disease, hyperlipidemia, cardiomyopathy, malignancy, arthritis, infertility, sleep apnea, and psychosocial impairments. Given the fact that intentional weight loss improves many of these comorbidities,[4] much effort has gone into the development of effective treatment modalities focused on sustained weight loss. Unfortunately, conservative medical treatment programs (dietary regimen, behavioral modification, and exercise) have been largely unsuccessful in achieving and maintaining long-term results in morbidly obese patients. Although initially promising, medical therapy has been limited by the side effects of the drugs and by their inability to maintain significant weight loss over long follow-up periods. Therefore, more aggressive treatment is typically required for obese subjects at risk for medical complications of obesity. Given these limitations, surgery has become an attractive alternative because it represents a long-term solution.

Bariatric surgery is a collective term for operations that involve reducing the size of the gastric reservoir with or without associated malabsorption. These operations have achieved impressive results, with approximately a 50% or more reduction in excess body weight by 18-24 months post operation.[5] Thus, it is not surprising that approximately 60,000-100,000 bariatric surgeries will be performed in the next year, and these numbers are rapidly escalating. Although most patients achieve successful outcomes, a significant proportion may develop postoperative gastrointestinal symptoms. Whether these symptoms represent "necessary evils" (adverse events related to dietary indiscretion) or "unnecessary evils" (postoperative complications) is difficult to interpret clinically, and frequently will require gastroenterology consultation. Thus, the aims of this review are (1) to familiarize the gastroenterologist with the various operations, (2) to describe the gastrointestinal complications associated with these operations, and (3) to discuss their management in a case-presentation format.

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