Complications following gastric bypass procedures for morbid obesity
Peltier, G.; Hermreck, A.S.; Moffat, R.E.; Hardin, C.A.; Jewell, W.R.
Surgery 86(4): 648-654
1979
ISSN/ISBN: 0039-6060 PMID: 483174 Document Number: 143517
Patients (400), who underwent gastric bypass (GB) for morbid obesity between January, 1974 and April, 1978, were studied. This series included 40 men and 360 women with a mean age of 34 yr (range, 15-73 yr). The average preoperative weight was 117 kg (range, 70-295 kg) and included patients undergoing synchronous takedown of small bowel bypass (SBB) and conversion to GB. In 283 patients the standard gastric division technique described by Mason and Printen was used; in the remaining 117 patients the gastric stapling technique described by Alden was utilized. The mean weight loss at 12 mo. was 31.5% and at 24 mo. averaged 31%. Seventy-seven patients were judged as having excellent or good results, whereas 23% had poor results because of inadequate weight loss or GB complications. A total of 10 deaths occurred (2.5%), with 4 resulting from anastomotic leaks, 2 from pulmonary embolus, 1 from respiratory failure and 3 late deaths. Ten anastomotic leaks (2.5%) developed and required operative intervention in 9 patients and observation in the remaining 1. In addition to the anastomotic leaks, another 9 patients suffered from intra-abdominal abscesses (7 subphrenics) and required operative drainage. Other serious complications included anastomotic bleeding or marginal ulcer in 7 patients, gastric outlet obstruction requiring reoperation in 6 patients, 17 wound infections and 17 wound hernias. Four patients developed vitamin B complex deficiency manifested by severe peripheral neuropathy. The GB results in a weight reduction equal to that achieved with the SBB. Chronic complications seen with the GB are fewer and less severe than seen with the SBB. The acute operative complications are substantial, basically technical in nature and should be reducible with further refinements in the GB procedure.