Clinical Review of Weight Loss Surgery, Procedures, Complications and Post Procedure Complications Management

Abstract

Introduction: Obesity is worldwide epidemic associated with serious complications both physical and psychological.Weight loss can be achieved with either medications or surgery, however the non-surgical options lacks durability more than two years. The weight loss surgical approaches classifies as: restrictive (adjustable gastric banding, vertical band gastroplasty), restrictive/resective (sleeve gastrectomy), restrictive/malabsorptive (Roux-en-Y gastric bypass, biliopancreatic diversion with duodenal switch) and purely malabsorptive (duodenal switch) options. Aim: Clinical review of different weight loss surgeries, mechanism of achieving weight loss, and complications of each procedure. Management of possible complications for each procedure. Results: [I] Gastric bypass (open and laparoscopic): the most commonly performed operation for long-term weight control in United States. Provides longstanding weight loss, better control of comorbidities as well as post procedure nutritional sequelae. Complications are (1) anastomotic leak (1–5.6%) and management either relaproscopy if detected early or radiological guided drainage for contained collection (2) anastomotic stricture (3- 11%) which can be managed by endoscopic dilatation or surgery (3) internal hernia require reoperation and closure of the defect. [II] Laparoscopic adjustable gastric band: the commonest weight loss surgery procedure in UK, complications are: (1) Pouch enlargement, (2) band erosion and (3) Band slip. [III] Sleeve gastrectomy: It is restrictive procedure involve neither anastomosis nor malabsortion and it is irreversible. Produce its clinical effect by early satiety from stomach volume loss and low circulating ghrelin levels. Complications (1) gastric leak: From staple line with incidence of 0.7-5%. If detected early (>4days) requires urgent surgical repair, however late presentation (5-10 day) for conservative management (2) bleeding. [IV] Biliopancreatic Diversion with Duodenal Switch (BPD/DS), components of the procedure are: (1) sleeve gastrectomy. (2) Division of duodenum between pylorus and sphincter of oddi. (3) Bypassing proximal small intestine through alimentary limb; distal 250 cm of the small intestine from ICV anastomosed end to end with post pyloric duodenum, while billiopancreatic limb has blind end proximal to sphincter of oddi anastomosed distally ileo-ileal about75 to 100 cm from ICV. Advantages are morbid obese patient can lose more weight and maintain it comparing with other bariatric procedures also it has a better control of comorbidities. Complications are: anastomotic leak, bleeding and nutritional deficiencies. Conclusion: Many surgical procedures have emerged as an acceptable bariatric surgical option for obese patients. Most of the bariatric procedures available nowadays offer beside weight loss, a better control of the obesity related comorbidities as Biliopancreatic Diversion with Duodenal Switch (BPD/DS), while others as adjustable gastric band have low complications rate which explains its popularity.