Weight Loss Surgery Complications and Risks 1 — Questions and Answers
Question 1: What is an internal hernia, and which bariatric procedure carries the greatest risk for it?
- Abdominal wall hernia after open surgery, most common with sleeve gastrectomy
- Bowel herniation through a mesenteric defect created during surgery, most common after Roux-en-Y gastric bypass (Correct answer)
- Hiatal hernia worsened by surgery, most common after gastric banding
- Port-site hernia, equally common after all laparoscopic procedures
Correct answer: Bowel herniation through a mesenteric defect created during surgery, most common after Roux-en-Y gastric bypass
Internal hernias occur when bowel protrudes through mesenteric defects created during RYGB construction, causing intermittent bowel obstruction.
Question 2: What is the most common early complication of bariatric surgery that requires emergency intervention?
- Nutritional deficiency
- Deep vein thrombosis / pulmonary embolism (Correct answer)
- Marginal ulcer
- Anastomotic stricture
Correct answer: Deep vein thrombosis / pulmonary embolism
DVT and pulmonary embolism are serious, potentially fatal early complications and are a leading cause of 30-day bariatric mortality.
Question 3: GERD (acid reflux) is known to worsen significantly after which bariatric procedure?
- Roux-en-Y gastric bypass
- Adjustable gastric banding
- Sleeve gastrectomy (Correct answer)
- Biliopancreatic diversion
Correct answer: Sleeve gastrectomy
Sleeve gastrectomy can worsen or cause GERD because it reduces lower esophageal sphincter pressure and increases intragastric pressure.
Question 4: What is reactive hypoglycemia (late dumping) after bariatric surgery and how is it managed?
- Low blood sugar from skipping meals, managed with glucose tablets
- Post-meal blood sugar spike followed by insulin overshoot causing hypoglycemia, managed with small frequent low-carb meals (Correct answer)
- Blood sugar drop during surgery, managed with IV glucose
- Chronic low blood sugar from reduced food intake, managed with glucagon injections
Correct answer: Post-meal blood sugar spike followed by insulin overshoot causing hypoglycemia, managed with small frequent low-carb meals
Reactive hypoglycemia occurs 1–3 hours after eating due to rapid carbohydrate absorption causing excessive insulin release; managed with dietary modification.
Question 5: Which bariatric complication presents with abdominal pain, tachycardia, and fever within 48 hours of surgery and is considered a surgical emergency?
- Nausea and vomiting from anesthesia
- Anastomotic or staple-line leak (Correct answer)
- Constipation from reduced food intake
- Wound infection at port sites
Correct answer: Anastomotic or staple-line leak
Anastomotic leak causes leakage of gastric contents into the peritoneum, rapidly leading to sepsis and requiring urgent surgical management.
Question 6: What is 'weight regain' after bariatric surgery typically defined as?
- Gaining back any weight lost
- Gaining back ≥ 50% of excess weight lost (Correct answer)
- Gaining back more than 5 lbs after reaching goal weight
- Returning to pre-surgery weight
Correct answer: Gaining back ≥ 50% of excess weight lost
Clinically significant weight regain is typically defined as regaining ≥ 50% of the maximum excess weight lost after bariatric surgery.
Weight Loss Surgery Complications and Risks 1
What is an internal hernia, and which bariatric procedure carries the greatest risk for it?