Moustafa, A., Marzouk, M., Nesem, M. (2018). Recent Advances in Management of Postoperative Vomiting for Laparoscopic Bariatric Surgeries. The Egyptian Journal of Hospital Medicine, 72(10), 5362-5366. doi: 10.21608/ejhm.2018.11277
Alaa Abbass Moustafa; Mohammed Abd El Monem Marzouk; Mina Ezzat Almaz Nesem. "Recent Advances in Management of Postoperative Vomiting for Laparoscopic Bariatric Surgeries". The Egyptian Journal of Hospital Medicine, 72, 10, 2018, 5362-5366. doi: 10.21608/ejhm.2018.11277
Moustafa, A., Marzouk, M., Nesem, M. (2018). 'Recent Advances in Management of Postoperative Vomiting for Laparoscopic Bariatric Surgeries', The Egyptian Journal of Hospital Medicine, 72(10), pp. 5362-5366. doi: 10.21608/ejhm.2018.11277
Moustafa, A., Marzouk, M., Nesem, M. Recent Advances in Management of Postoperative Vomiting for Laparoscopic Bariatric Surgeries. The Egyptian Journal of Hospital Medicine, 2018; 72(10): 5362-5366. doi: 10.21608/ejhm.2018.11277
Recent Advances in Management of Postoperative Vomiting for Laparoscopic Bariatric Surgeries
General Surgery Department, Faculty of Medicine, Ain Shams University
Abstract
Background and Objectives: obesity continues to be a leading public health concern associated with many comorbidities that significantly decrease life expectancy. Surgery remains the only effective treatment modality for morbid obesity, resulting in long-term weight loss and sustained improvement in weight-related comorbidities. Vomiting is considered as a possible postoperative complication in all bariatric procedures. Anastomotic leak is one of the most serious complications following bariatric laparoscopic Roux-en-Y gastric bypass (LRYGB) and associated with high morbidity rates and prolonged hospital stay. Timely management is of utmost importance for the clinical outcome. This study evaluated the approach to suspected leakage in a high-volume bariatric surgery unit. Patients and Methods: the study has been conducted on 100 Patients with morbid obesity. Observational checklist including: Age at the time of operation, body mass index (BMI), preoperative gastroesophageal reflux disease (GERD) and newly developed postoperative upper gastrointestinal symptoms. Invasive manoeuvres as gastrographin swallow and meal, virtual gastroscopy and upper gastroIntestinal endoscopy were done upon patients who developed post-operative vomiting after LBS for two months. Go to: Results: 100 Patients who underwent LBS included 85% women, 42 ± 10 years old, body mass index 43,8 ± 5,4 kg/m2, sleeve gastrectomy 71%, minigastric bypass surgery 24%, Roux-en-Y gastric bypass 5%. During the first 48 post-operative hours, 39% of patients developed postoperative vomiting which was controlled with medical treatment (Aprepitant). 4% of them suffered from recurrent episodes of vomiting over a period of two months were surgically complicated (stenosis, kinking, or obstruction). Endoscopic treatment was successful for 3 of the 4 patients (75%) after balloon dilatation or insertion of a stent. One of the 4 patients (25%) required conversion to Roux-en-Y gastric bypass. Conclusion: post-operative vomiting after Laparoscopic Bariatric Surgeries (LBS) is a common complication which responds well to centrally acting antiemetic (Aprepitant) during the first 48 post-operative hours. While invasive maneuvers (Balloon dilatation or insertion of a stent) or even surgical correction might be needed.
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