Post-bariatric complications-leaks

Laparoscopic bariatric procedures offer effective treatments for medically complicated obesity, and as experience grows in this surgical specialty and also due to the success of the Fellowships overseen by the Fellowship Council, complications are becoming remarkably rare. The vast majority of patients undergoing a bariatric procedure can expect minimal postoperative pain, a hospital stay of less than 48 h, and dramatic weight loss with improvement in obesity-related comorbid diseases within the first year. Despite the complexity of these procedures coupled with the technical challenges inherent to operating on obese patients, perioperative morbidity and mortality are low. The two most important causes of early postoperative morbidity are pulmonary embolism and enteric leak; in this chapter, we will focus on diagnosis and management of the latter, although it is important to realize that these two complications may mimic one another in terms of signs and symptoms. We will present and dissect a case report illustrating the important principles of postoperative management of this complication. Leaks after bariatric operations are potentially life-threatening, and management of leaks depends largely on the timing and severity of illness at presentation. A high index of suspicion is warranted, because a delay in diagnosis and treatment can very realistically be the difference between a favorable outcome and death.