Document Detail


Management of acute bleeding after laparoscopic Roux-en-Y gastric bypass.
MedLine Citation:
PMID:  14738667     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The authors reviewed the incidence of hemorrhage after laparoscopic Roux-en-Y gastric bypass (LRYGBP). The purpose of this study was to determine the incidence of this complication and to evaluate various treatment options. MATERIAL AND METHODS: The records for 450 consecutive patients who had undergone LRYGBP over a 30-month period, were retrospectively reviewed. In all patients, the abdominal cavity had been drained with 2 19-Fr closed suction drains. The charts of patients who had developed an intraluminal or an intraabdominal bleed were chosen for further review. RESULTS: 20 patients (4.4%) developed an acute postoperative hemorrhage. The bleeding was intraluminal in 12 cases (60%), manifested by a drop in hematocrit, tachycardia and melena. The other 8 patients (40%) developed intra-abdominal hemorrhage, confirmed by large bloody output from the drains. 3 patients (15%) with intraluminal bleeding were unstable and required a reoperation. All others were successfully treated with observation, and 15 patients (75%) required blood transfusions. CONCLUSIONS: The diagnosis and treatment of acute intraluminal bleeding after LRYGBP represents a surgical dilemma, mainly due to the inaccessibility of the bypassed stomach and the jejuno-jejunostomy, as well as the risks associated with early postoperative endoscopy. The presence of large intra-abdominal drains allows for bleeding site localization (intraluminal vs intraabdominal) and for more accurate monitoring of the bleeding rate. Most cases respond to conservative therapy. Failure of conservative management of intraluminal bleeding, however, is more problematic and may require operative intervention. A treatment algorithm is proposed.
Authors:
Amir Mehran; Samuel Szomstein; Nathan Zundel; Raul Rosenthal
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Obesity surgery     Volume:  13     ISSN:  0960-8923     ISO Abbreviation:  Obes Surg     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2004-01-23     Completed Date:  2004-05-04     Revised Date:  2007-12-05    
Medline Journal Info:
Nlm Unique ID:  9106714     Medline TA:  Obes Surg     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  842-7     Citation Subset:  IM    
Affiliation:
The Bariatric Institute, Cleveland Clinic Florida, Weston, FL. USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Algorithms
Anastomosis, Roux-en-Y
Female
Gastric Bypass / adverse effects*,  methods
Gastrointestinal Diseases / epidemiology,  etiology,  therapy
Gastrointestinal Hemorrhage / epidemiology,  etiology,  therapy*
Humans
Incidence
Laparoscopy / adverse effects*
Male
Middle Aged
Postoperative Hemorrhage / epidemiology,  etiology,  therapy*
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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