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Management von Frühkomplikationen in der Adipositaschirurgie

Management of complications in bariatric surgery

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Zusammenfassung

Adipositaschirurgie ist die effektivste und langfristig wirksamste Maßnahme in der Behandlung der krankhaften Adipositas und vieler ihrer Folgeerkrankungen. Die Patienten sind jedoch aufgrund ihrer Begleit- und Folgeerkrankungen sowie eingeschränkter Reserven kardiopulmonaler Funktionen Hochrisikopatienten. Das Komplikationsmanagement unterscheidet sich im Hinblick auf Klinik, Diagnostik und Zeitdruck erheblich von unerwarteten Ereignissen nach viszeralchirurgischen Eingriffen bei „Normalgewichtigen“. Jede Abweichung von einem normalen postoperativen Verlauf, insbesondere das Auftreten von Tachykardie, unklaren Schmerzen, Tachypnoe, Fieber, aber auch unerwartet hohe oder ansteigende Entzündungsparameter zwingen zum raschen Handeln. Die frühzeitige Relaparoskopie besitzt bei einer abdominellen Symptomatik einen besonderen Stellenwert und kann vielfach die bildgebende Diagnostik, die bei extrem hohen Körpermassen technisch schwierig und in der Aussagekraft limitiert ist, ersetzen. Sie ermöglicht zugleich vielfach die Therapie.

Abstract

Bariatric surgery is known to be the most effective and long-lasting treatment for morbid obesity and associated comorbidities. These comorbidities together with cardiopulmonary decompensation make morbidly obese patients a high risk group for operative interventions. Early detection of postoperative complications is a challenging task in these patients and requires accurate and timely interpretation of any alarm signals. Symptoms, such as tachycardia and abdominal pain are highly suspicious. The same applies to elevated inflammatory parameters and fever. Early diagnostic laparoscopy is mandatory once cardiopulmonary complications have been excluded. Moreover, it has a higher sensitivity and specificity than other radiological modalities and is a minimally invasive procedure with a highly satisfactory outcome.

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Literatur

  1. Weiner RA, El-Sayes IA, Theodoridou S et al (2013) Early Post-operative Complications: Incidence, Management, and Impact on Length of Hospital Stay. A Retrospective Comparison between Laparoscopic Gastric Bypass and Sleeve Gastrectomy. Obes Surg. doi:10.1007/s11695-013-1022-z

  2. Runkel N, Colombo-Benkmann M, Hüttl TP et al (2011) Evidence-based German guidelines for surgery for obesity. Int J Colorectal Dis 26(4):397–404

    Article  PubMed  Google Scholar 

  3. Stroh C, Weiner R, Horbach T et al (2013) Aktuelle Daten der Qualitätssicherungsstudie für operative Therapie der Adipositas in Deutschland. Zentralbl Chir 138(2):180–188

    CAS  PubMed  Google Scholar 

  4. Chakravartty S, Sarma DR, Patel AG (2013) Rhabdomyolysis in bariatric surgery: a systematic review. Obes Surg 23(8):1333–1340

    Article  PubMed  Google Scholar 

  5. Theodorou D, Doulami G, Larentzakis A et al (2012) Bougie insertion: a common practice with underestimated dangers. Int J Surg Case Rep 3(2):74–77

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Weiner R, Peterli R (2012) Laparoscopic sleeve gastrectomy. In: Immenroth M, Brenner J (Hrsg) Operation Primer. Springer, Germany

  7. Dick A, Byrne TK, Baker M et al (2010) Gastrointestinal bleeding after gastric bypass surgery: nuisance or catastrophe? Surg Obes Relat Dis 6(6):643–647

    Article  PubMed  Google Scholar 

  8. Rabl C, Peeva S, Prado K et al (2011) Early and late abdominal bleeding after Roux-en-Y gastric bypass: sources and tailored therapeutic strategies. Obes Surg 21(4):413–420

    Article  PubMed  Google Scholar 

  9. Bostanjian D, Anthone J, Hamoui N et al (2003) Rhabdomyolysis of gluteal muscles leading to renal failure: a potentially fatal complication of surgery in the morbidly obese. Obes Surg 13(2):302–305

    Article  PubMed  Google Scholar 

  10. Büller R, Agnelli G, Hull D et al (2004) Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126(Suppl 3):401S–428S

    Article  PubMed  Google Scholar 

  11. Smith MD, Patterson E, Wahed AS et al (2011) Thirty-day mortality after bariatric surgery: independently adjudicated causes of death in the longitudinal assessment of bariatric surgery. Obes Surg 21(11):1687–1692

    Article  PubMed Central  PubMed  Google Scholar 

  12. Birkmeyer N, Dimick J, Share D et al (2010) Hospital complication rates with bariatric surgery in Michigan. JAMA 304:435–442

    Article  CAS  PubMed  Google Scholar 

  13. Morino M, Toppino M, Forestieri P et al (2007) Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry. Ann Surg 246(6):1002–1007

    Article  PubMed  Google Scholar 

  14. Chakravartty S, Sarma DR, Patel AG (2013) Rhabdomyolysis in bariatric surgery: a systematic review. Obes Surg 23(8):1333–1340

    Article  PubMed  Google Scholar 

  15. Lagandré S, Arnalsteen L, Vallet B et al (2006) Predictive factors for rhabdomyolysis after bariatric surgery. Obes Surg 16(10):1365–1370

    Article  PubMed  Google Scholar 

  16. Weiner R, Daskalakis M, Theodoridou S et al (2009) Systemic thrombolysis for acute massive pulmonary embolism in the immediate postoperative period after bariatric surgery. Surg Obes Relat Dis 5(2):271–274

    Article  PubMed  Google Scholar 

  17. Rosenberg JM, Tedesco M, Yao DC et al (2012) Portal vein thrombosis following laparoscopic sleeve gastrectomy for morbid obesity. JSLS 16(4):639–643

    Article  PubMed Central  PubMed  Google Scholar 

  18. Abunnaja S, Cuviello A, Dhamija A et al (2013) Do routine postoperative upper gastrointestinal studies following laparoscopic gastric bypass affect clinical outcomes? Conn Med 77(7):395–398

    PubMed  Google Scholar 

  19. Aurora AR, Khaitan L, Saber AA (2012) Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc 26(6):1509–1515

    Article  PubMed  Google Scholar 

  20. Burgos AM, Braghetto I, Csendes A et al (2009) Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg 19(12):1672–1677

    Article  PubMed  Google Scholar 

  21. Ruiz-Tovar J, Oller I, Galindo I et al (2013) Change in levels of C-reactive protein (CRP) and serum cortisol in morbidly obese patients after laparoscopic sleeve gastrectomy. Obes Surg 23(6):764–769

    Article  PubMed  Google Scholar 

  22. Chang CC, Lee WJ, Ser KH et al (2011) Routine drainage is not necessary after laparoscopic gastric bypass. Asian J Endosc Surg (2):63–67

    Article  Google Scholar 

  23. Kavuturu S, Rogers AM, Haluck RS (2012) Routine drain placement in Roux-en-Y gastric bypass: an expanded retrospective comparative study of 755 patients and review of the literature. Obes Surg 22(1):177–181

    Article  PubMed  Google Scholar 

  24. ASMBS Clinical Issues Committee (2009) ASMBS guideline on the prevention and detection of gastrointestinal leak after gastric bypass including the role of imaging and surgical exploration. Surg Obes Relat Dis 5(3):293–296

    Article  Google Scholar 

  25. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA et al (2012) International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of > 12,000 cases. Surg Obes Relat Dis 8(1):8–19

    Article  PubMed  Google Scholar 

  26. Weiner, R, V.Emmerlich, D Wagner D et al (1998) Management und Therapie von postoperativen Komplikationen nach „gastric banding“ wegen morbider Adipositas. Chirurg 69:1082–1088

    Article  CAS  PubMed  Google Scholar 

  27. Freedman J, Jonas E, Näslund E et al (2013) Treatment of leaking gastrojejunostomy after gastric bypass surgery with special emphasis on stenting. Surg Obes Relat Dis 9(4):554–558

    Article  PubMed  Google Scholar 

  28. Weiner RA (2009) Adipositaschirurgie. Elsevier

  29. Mittermair R, Sucher R, Perathoner A (2013) Results and complications after laparoscopic sleeve gastrectomy. Surg Today (Epub ahead of print)

  30. Sakran N, Goitein D, Raziel A et al (2013) Gastric leaks after sleeve gastrectomy: a multi-center experience with 2,834 patients. Surg Endosc 27(1):240–245

    Article  PubMed  Google Scholar 

  31. Simon F, Siciliano I, Gillet A et al (2013) Gastric leak after laparoscopic sleeve gastrectomy: early covered self-expandable stent reduces healing time. Obes Surg 23(5):687–692

    Article  CAS  PubMed  Google Scholar 

  32. Pequignot A, Fuks D, Verhaeghe P et al (2012) Is there a place for pigtail drains in the management of gastric leaks after laparoscopic sleeve gastrectomy? Obes Surg 22(5):712–720

    Article  CAS  PubMed  Google Scholar 

  33. El Hassan E, Mohamed A, Ibrahim M et al (2013) Single-stage operative management of laparoscopic sleeve gastrectomy leaks without endoscopic stent placement. Obes Surg 23(5):722–726

    Article  Google Scholar 

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Förderung

Die Qualitätssicherungsstudie wird gefördert 1. vom Institut für operative Therapie der Adipositas der Otto-von-Guericke-Universität Magdeburg, 2. Vom BMBF im Rahmen des Kompetenznetz Adipositas seit 01.04.2011; Fördernummer 01GI1124 und 3. von der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie mit ihrer Arbeitsgemeinschaft der Chirurgische Arbeitsgemeinschaft Adipositastherapie (CAADIP).

Einhaltung ethischer Richtlinien

Interessenkonflikt. R.A. Weiner führt Trainingskurse für Chirurgen in Zusammenarbeit mit den Firmen Ethicon Endosurgery, Covidien, Storz, Olympus und AMI durch. Die Honorare fließen dem Drittmittelkonto der Klinik zu. C. Stroh, I. El-Sayes, M. Frenken, S. Theodoridou, O. Scheffel und S. Weiner geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Weiner, R., Stroh, C., El-Sayes, I. et al. Management von Frühkomplikationen in der Adipositaschirurgie. Chirurg 86, 56–66 (2015). https://doi.org/10.1007/s00104-013-2703-9

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  • DOI: https://doi.org/10.1007/s00104-013-2703-9

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