June 26, 2024

Bariatric surgery has emerged as a powerful, highly effective tool in treating obesity and associated comorbidities such as type 2 diabetes mellitus and heart disease. Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are both effective procedures for weight loss and currently comprise more than 75% of the procedures performed. RYGB is currently viewed as the most effective treatment for obesity, achieving up to approximately 30% total body weight loss within the first 1 to 2 years after surgery. Additionally, the weight loss achieved by patients who undergo RYGB appears durable, allowing patients to maintain more than 25% of total weight loss for over two decades.

As these procedures become more common, it's crucial to understand the potential postsurgical complications that can arise and how best to manage them. In a review article published in Gastroenterology Clinics of North America in 2023, Barham K. Abu Dayyeh, M.D., M.P.H., and co-authors sought to provide a comprehensive overview of the most common postbariatric surgery complications and the role of endoscopy in their management. Dr. Abu Dayyeh is a gastroenterologist who leads the Advanced Endoscopy Innovation Translation and Clinical Trials Group at Mayo Clinic in Rochester, Minnesota.

Overall, the complication rate after bariatric surgery is approximately 15%, although most complications are minor. Dr. Abu Dayyeh and co-authors note that some of these complications can stem from the complexity of the surgical anatomy, the use of multiple staple lines and anastomoses, and the fact that the remnant stomach remains physiologically active after RYGB.

Postsurgical complications

"This research highlights the important role of endoscopic techniques in addressing postbariatric surgery complications, leading to significant improvements in patient outcomes," says Dr. Abu Dayyeh. "Endoscopy offers minimally invasive solutions, including endoscopic suturing and stenting, resulting in high success rates and minimal adverse effects. In the appropriate clinical settings, endoscopic techniques present preferable alternatives to more invasive surgical revisions for complications like leaks, ulcers, stenosis, fistulas, and even weight regain in select patients. The study's findings offer valuable guidance for clinicians, potentially enhancing patient outcomes, optimizing recovery times, and reducing the need for further surgeries. Ultimately, we are hopeful that these endoscopic approaches will improve the overall effectiveness of bariatric surgery in treating obesity."

Future research and advancement

According to Dr. Abu Dayyeh, the next steps involve generating evidence-based guidelines for applying endoscopic techniques to manage postbariatric complications and weight regain. "This research will validate and refine these techniques, contributing to standardized protocols for widespread clinical adoption. By expanding the therapeutic options available to healthcare professionals, these advancements will enhance the overall management of postsurgical complications."

A collaborative team at Mayo Clinic is actively engaged in developing the next generation of endoscopic and surgical bariatric interventions. "Our goal is to extend the benefits of bariatric and metabolic surgery to a wider patient population through innovative approaches that leverage similar pathways while preserving anatomy, improving quality of life, and reducing financial burdens," says Dr. Abu Dayyeh.

For more information

Gala K, et al. Endoscopic management of surgical complications of bariatric surgery. Gastroenterology Clinics of North America. 2023;52:719.

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