BLEEDING FOLLOWING BARIATRIC SURGERY (TYPES & MANAGEMENT MODALITIES)

Bleeding is a serious complication following bariatric procedures such as Minigastric bypass (MGB), Roux-En-Y Gastric Bypass (RYGB) Surgery, and Sleeve Gastrectomy (SG). Post bariatric bleeding is either acute or chronic. Although this complication is declined now, but still it is important to know because if it is not managed urgently it will lead to serious results. The source of bleeding may be from the staple lines, unexpected injury to the spleen, or to one of the blood vessels around the surgical field. The other source of bleeding may be internal through the GIT and it is presented as hematemesis or melena. Gastrointestinal bleeding in patients underwent bariatric surgery may occur in the esophagus, gastric pouch, new sleeved stomach, the Roux limb just distal to the anastomosis, the remaining of the small intestine. The site of bleeding can be determined and treated mostly by endoscopy but in certain cases may require re-laparoscopy. The aim of this study is to analyze the incidence, types and management of this bleeding. This is a prospective study which has been done in Al-Sadr Teaching Hospital, Basrah, Iraq, from June 2015 to June 2017. The study included 540 case who were subjected to SG, RYGB, MGB and they were analyzed regarding; time of occurrence, postoperative bleeding, types whether intra-peritoneal or intra-luminal and type of approaches for treating this bleeding. In our study we don’t over sewn the staple line and didn't use any buttressing material or synthetic coagulation powder. The total number of patients developed post-operative bleeding were 18 cases out of 540, 12 after sleeve gastrectomy, 3 after mini gastric bypass and 3 after Roux-En-Y. Regarding sleeve gastrectomy; two patients of the required re-laparoscopy and evacuation of hematoma with treating site of bleeding by clipping or suturing according to the condition, three patients required aspiration under ultrasound guide, while the remaining 7 cases were kept only under conservative measures. The 3 patient of the MGB were managed conservatively and the 3 cases of Roux-En-Y were managed either conservatively in 2 cases or by endoscopic intervention in one case. In conclusion, we advise the surgeons to use reinforcement of staple line to decrease incidence of post-operative bleeding. Introduction besity is a major health problem worldwide that leads to increased incidence of morbidity and mortality. People are generally regarded obese when their body mass index (BMI) exceeded 30 kg/m, and above the 25kg/m were regarded as overweight. Obesity is a risk factor of many diseases like cardiovascular diseases, diabetes, sleep apnea, osteoarthritis, depression, and rarely cancer. Life style modification such as change in diet quality and exercise can control obesity. If diet modification, exercise, and medication failed to control morbid obesity, a gastric balloon or surgery should be considered to solve the problem. The choice of procedure depends on BMI, food habit, co-morbid diseases and psychological state. Bariatric surgery is regarded as the best modality that gives a significant weight loss for morbidly obese patients and according to a medical guideline by O