Post-Bariatric Surgery Complications Management

Algorithm Steps

1. ▶

   Start

   Suspected Post-Bariatric Complication

   Tachycardia, pain, fever, N/V

   1. ◆

      Decision

      Timing of Complication

      • Early (<30 days)
      • Late (>30 days)
      1. ◆

         Decision

         Early (<30 days)

         • Leak (most feared)
         • Bleeding
         • Obstruction/stricture
         • VTE/PE
         1. ●

            Action

            Leak Workup

            CT with oral contrast

            • Tachycardia = leak until proven otherwise
            • Low threshold for OR if unstable
            1. ●

               Action

               Leak Management

               Drain, stent, or washout

               • Contained/stable: NPO, drain, stent/EVT
               • Unstable: OR washout, drainage
               1. ■

                  End

                  Resolution & Follow-up

                  Bariatric center follow-up, nutritional monitoring

         2. ●

            Action

            Bleeding Management

            Intraluminal vs extraluminal

            • Intraluminal: EGD, usually self-limited
            • Extraluminal: CT, may need OR/IR
         3. ●

            Action

            Stricture

            EGD with balloon dilation

            • 15-18mm target
            • Multiple dilations may be needed
      2. ◆

         Decision

         Late (>30 days)

         • Internal hernia
         • Marginal ulcer
         • Stricture
         • GERD (sleeve)
         1. ●

            Action

            Internal Hernia

            Petersen's, JJ, mesocolic

            • CT: mesenteric swirl sign
            • May be CT-negative - clinical suspicion key
            • Diagnostic laparoscopy if suspicious
         2. ●

            Action

            Marginal Ulcer

            EGD, high-dose PPI

            • Stop NSAIDs, smoking cessation
            • H. pylori treatment if +
            • Revision if refractory