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Abdominal pain after gastric bypass in the acute general surgical care setting

Zaigham, Hassan LU orcid ; Ekelund, Mikael LU ; Regnér, Sara LU orcid and Olsson, Åsa LU (2020) In Surgery for Obesity and Related Diseases 16(12). p.2058-2067
Abstract

Background: Managing acute abdominal pain in the large and growing population of Roux-en-Y gastric bypass (RYGB)–operated patients poses a challenge to general surgeons, because of diagnostic limitations and the risk of internal herniation. Objective: To investigate the diagnoses, management, and outcome of RYGB patients admitted for acute abdominal pain. Setting: University Hospital, Sweden. Methods: Prospective inclusion of 280 consecutive RYGB patients admitted for acute abdominal pain between April 2012 and June 2015. Readmissions, surgical procedures, and overall mortality were recorded until October 2018. Medical records were retrospectively reviewed for anthropometric measures, medical history, time from RYGB surgery, and... (More)

Background: Managing acute abdominal pain in the large and growing population of Roux-en-Y gastric bypass (RYGB)–operated patients poses a challenge to general surgeons, because of diagnostic limitations and the risk of internal herniation. Objective: To investigate the diagnoses, management, and outcome of RYGB patients admitted for acute abdominal pain. Setting: University Hospital, Sweden. Methods: Prospective inclusion of 280 consecutive RYGB patients admitted for acute abdominal pain between April 2012 and June 2015. Readmissions, surgical procedures, and overall mortality were recorded until October 2018. Medical records were retrospectively reviewed for anthropometric measures, medical history, time from RYGB surgery, and previous closure of mesenteric gaps. Admissions were separated into early (≤30 d) or late (>30 d) after RYGB. Procedures performed were categorized as follows: RYGB complication, other surgery, or unremarkable laparoscopy. Patients discharged with diagnosis of unspecified abdominal pain were separately analyzed. Diagnostic investigations, bariatric competency, on call surgery, surgical complications, and length of stay were registered. Results: In late admissions, the cause of the abdominal complaints remained unexplained in 127 of 262 (48%) patients despite 95 abdominal computed tomographies and 28 diagnostic laparoscopies. Emergency surgery was performed in 128 of 262 (49%) patients. RYGB complications (n = 66), mainly internal herniation (n = 42), were >2 times more frequent than other surgical procedures (n = 32), such as cholecystectomies (n = 23). Internal herniation could occur at any time interval from RYGB surgery and regardless of previously closed mesenteric gaps. Conclusion: Better tools for evaluation of acute abdominal pain in RYGB patients are needed to reduce the number of unremarkable laparoscopies and admissions of patients with unspecified abdominal pain.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Abdominal pain, Bariatric surgery, Complications, Emergency surgery, Internal herniation, Roux-en-Y gastric bypass
in
Surgery for Obesity and Related Diseases
volume
16
issue
12
pages
10 pages
publisher
Elsevier
external identifiers
  • scopus:85089751373
  • pmid:32839123
ISSN
1550-7289
DOI
10.1016/j.soard.2020.07.008
language
English
LU publication?
yes
id
355d6865-7ae8-428d-aa4f-5518a735613d
date added to LUP
2020-09-08 14:51:54
date last changed
2024-06-26 21:46:39
@article{355d6865-7ae8-428d-aa4f-5518a735613d,
  abstract     = {{<p>Background: Managing acute abdominal pain in the large and growing population of Roux-en-Y gastric bypass (RYGB)–operated patients poses a challenge to general surgeons, because of diagnostic limitations and the risk of internal herniation. Objective: To investigate the diagnoses, management, and outcome of RYGB patients admitted for acute abdominal pain. Setting: University Hospital, Sweden. Methods: Prospective inclusion of 280 consecutive RYGB patients admitted for acute abdominal pain between April 2012 and June 2015. Readmissions, surgical procedures, and overall mortality were recorded until October 2018. Medical records were retrospectively reviewed for anthropometric measures, medical history, time from RYGB surgery, and previous closure of mesenteric gaps. Admissions were separated into early (≤30 d) or late (&gt;30 d) after RYGB. Procedures performed were categorized as follows: RYGB complication, other surgery, or unremarkable laparoscopy. Patients discharged with diagnosis of unspecified abdominal pain were separately analyzed. Diagnostic investigations, bariatric competency, on call surgery, surgical complications, and length of stay were registered. Results: In late admissions, the cause of the abdominal complaints remained unexplained in 127 of 262 (48%) patients despite 95 abdominal computed tomographies and 28 diagnostic laparoscopies. Emergency surgery was performed in 128 of 262 (49%) patients. RYGB complications (n = 66), mainly internal herniation (n = 42), were &gt;2 times more frequent than other surgical procedures (n = 32), such as cholecystectomies (n = 23). Internal herniation could occur at any time interval from RYGB surgery and regardless of previously closed mesenteric gaps. Conclusion: Better tools for evaluation of acute abdominal pain in RYGB patients are needed to reduce the number of unremarkable laparoscopies and admissions of patients with unspecified abdominal pain.</p>}},
  author       = {{Zaigham, Hassan and Ekelund, Mikael and Regnér, Sara and Olsson, Åsa}},
  issn         = {{1550-7289}},
  keywords     = {{Abdominal pain; Bariatric surgery; Complications; Emergency surgery; Internal herniation; Roux-en-Y gastric bypass}},
  language     = {{eng}},
  month        = {{12}},
  number       = {{12}},
  pages        = {{2058--2067}},
  publisher    = {{Elsevier}},
  series       = {{Surgery for Obesity and Related Diseases}},
  title        = {{Abdominal pain after gastric bypass in the acute general surgical care setting}},
  url          = {{http://dx.doi.org/10.1016/j.soard.2020.07.008}},
  doi          = {{10.1016/j.soard.2020.07.008}},
  volume       = {{16}},
  year         = {{2020}},
}