Bariatric surgery sequelae

Last reviewed: 7 Jan 2023

Last updated: 10 Aug 2022

Obesity and inactivity are responsible for 365,000 deaths per year in the US.[1][2][3] The incidence of class III obesity (body mass index of 40 or above) is increasing at a rapid rate, and this has resulted in an increase in bariatric operations worldwide. In large-scale prospective trials, obesity surgery has been shown to result in improved quality of life and a decreased risk of death for people of all ages with class III obesity.[4][5][6][7][8][9][10] Studies demonstrate that children and adolescents with class III obesity benefit from weight loss surgery.[11]Patients with class II (body mass index of 35 to 39.9) to class III obesity should undergo a comprehensive assessment and receive care in the immediate and distant postoperative course from weight loss surgery.[12]

Bariatric surgery (also referred to as metabolic surgery) is also being investigated as a possible primary therapy for type 2 diabetes. Results from randomized controlled trials and systematic reviews with meta-analyses have shown superior glycemic control with bariatric surgery compared with conventional medical therapy alone in people with obesity and type 2 diabetes.[13][14][15][16][17] Furthermore, guidelines from the American Diabetes Association, the UK-based National Institute for Health and Care Excellence, and the International Diabetes Foundation, recommend the use of bariatric surgery in people with obesity and type 2 diabetes who have inadequate glycemic control on optimal medical therapy alone.[18][19][20][21]

In one small randomized trial, bariatric surgery reduced the number of antihypertensive medications (≥30%) required to maintain blood pressure control in people with obesity and hypertension compared with medical therapy alone.[22]

The mechanism of action of bariatric surgery for obesity is not fully understood but is believed to include gastric volume restriction, malabsorption, and hormonal changes.[23][24]

After bariatric surgery, patients may present to clinics, emergency departments, or a hospital other than the one where they had the operation. Thus, knowledge of common complications is necessary.[25] The abdomen with central adiposity may be difficult to examine and can mask typical signs of sepsis. Careful attention to vital signs, examination findings, and any deviation from expected postoperative course is essential.

In order to help patients sustain weight loss after bariatric surgery, regular self-monitoring and frequent postoperative follow-up visits may be required.[26]

Details

Types of surgical procedures
Expected weight loss
Gastric bypass: description
Gastric bypass: early complications
Gastric bypass: late complications
Gastric band: description
Gastric band: early complications
Gastric band: late complications
Biliopancreatic diversion (BPD) with or without duodenal switch: description
Biliopancreatic diversion (BPD) with or without duodenal switch: complications
Sleeve gastrectomy: description
Sleeve gastrectomy: complications
Vertical banded gastroplasty (VBG)
Jejunoileal bypass
Metabolic and nutritional complications
Bone and mineral metabolism
Bariatric surgery and the pregnant patient
Weight loss failure or weight regain following bariatric surgery
Abdominal pain following bariatric surgery
Nausea and vomiting following bariatric surgery

Full details

Contributors

Authors

Fatima Cody Stanford, MD, MPH, MPA

Obesity Medicine Physician Medicine

Gastrointestinal Unit, Department of Medicine

Division of Endocrinology, Department of Pediatrics

Massachusetts General Hospital/Harvard Medical School

Boston

Disclosures

FCS is the author of an article cited in the topic.

Acknowledgements

Dr Fatima Cody Stanford would like to gratefully acknowledge Dr Abeezar Sarela and Dr Daniel M. Herron, previous contributors to this topic. AS has no competing interests. DMH has received educational grants from Ethicon Endosurgery and Covidien. DMH has acted as consultant for USGI Medical, Virtual Incision, and Hourglass Technology.

Peer reviewers

David Arterburn, MD

Assistant Investigator

Group Health Center for Health Studies

Seattle

Disclosures

DA declares that he has no competing interests.

Evangelos Efthimiou, MBBS, MRCS

Consultant in Bariatric and General Surgery

Chelsea and Westminster Hospital

London

Disclosures

EE has been sponsored by Ethicon UK in a fellowship grant and has received sponsorship to attend conferences. EE has received speaking fees from Nestle UK.

Dara P. Schuster, MD, FACE

Associate Professor

Internal Medicine and Pediatrics

Associate Medical Director

Chronic Disease Management

Ohio State University Hospitals

Columbus

Disclosures

DPS declares that she has no competing interests.

Hutan Ashrafian, MBBS, MRCS

Clinical Lecturer in Surgery

Imperial College London

London

Disclosures

HA declares that he has no competing interests.

Patient leaflets
Obesity - drugs and surgery
Weight problems in children
More Patient leaflets
Log in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer

Bariatric surgery sequelae

Summary

Details

Contributors

Authors

Fatima Cody Stanford, MD, MPH, MPA

Disclosures

Acknowledgements

Peer reviewers

David Arterburn, MD

Disclosures

Evangelos Efthimiou, MBBS, MRCS

Disclosures

Dara P. Schuster, MD, FACE

Disclosures

Hutan Ashrafian, MBBS, MRCS

Disclosures

Patient leaflets

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice