Table 1. Risk, Prevention, and Treatment of Postoperative Gastrointestinal and Nutritional Complications in Bariatric Patients


Complication Risk by Procedure Prevention Treatment
LAGB RYGB BPD and DS
Nutritional
Vitamin deficiency
   Iron 0 ++ ++ Multivitamin with iron and vitamin C Ferrous sulfate 300 mg/d with vitamin C
   Vitamin B12 0 ++ + 1,000 μg/mo IM or 300-500 μg/d orally or nasal spray 500 μg/wk 1,000 μg/mo IM or 300-500 μg/d orally or 500 μg/wk nasal spray
   Folic acid 0 ++ ++ Folate 1 mg/d usually in multivitamin Folate 1 mg/d
   Fat-soluble vitamins A, D, E, K 0 + ++ Multivitamin, including at least 400 IU vitamin D Replace vitamin as indicated
   Thiamine 0 + ++ Multivitamin with thiamine 50 mg IV
   Mineral deficiency
   Calcium 0 + ++ 1,500 mg/d elemental calcium 1,500 mg/d elemental calcium
   Insufficient weight loss + 0 0 Obesity support group; dietary education Consider alternative bariatric operation
   Excessive weight loss 0 + ++ Dietary education; appropriate surgery Conduct dietary education; consider surgical revision
Hepatobiliary
   Gallstones and sludge + ++ ++ Ursodeoxycholic acid 300 mg twice daily for 6 mo; consider elective cholecystectomy Conduct cholecystectomy
Luminal
   Stomal ulceration 0 + + Avoid NSAIDs; consider prophylactic PPI (pouch must not be too large) Stop NSAIDs; prescribe PPI; conduct surgical revision
   Stomal stenosis 0 + + Surgical technique; prevent ulcers; avoid silastic band Conduct endoscopic dilation; remove silastic band; conduct surgical revision
   Band erosion + 0 0 Surgical technique Conduct surgical revision
   Staple line dehiscence 0 + 0 Surgical technique Conduct surgical revision
   Fistula 0 + + Surgical technique; prevent ulcers Treat endoscopically; consider surgical revision
   Internal hernia 0 + + Surgical technique Treat as surgical emergency
   Bile reflux 0 + 0 Roux limb must be long enough; rule out obstruction. Conduct surgical revision
   GI tract bleeding 0 + + Avoid NSAIDs Treat endoscopically; prescribe PPI
   Dumping syndrome 0 + + Small meals; dietary education Conduct dietary education; consider surgical reversal (rarely)
   GERD + 0 0 Choose correct procedure Prescribe PPI; conduct surgical revision
Functional
   Vomiting ++ + + Small meals; prevent ulceration and stenosis Dilate stenosis endoscopically; conduct surgical revision; conduct dietary education
   Diarrhea 0 + ++ Appropriate diet Treat infection; rule out bacterial overgrowth; administer loperamide; consider surgical revision
   Bloating and flatulence 0 + ++ Consider small-bowel bacterial overgrowth Exclude and treat bacterial overgrowth; conduct dietary education

BPD = biliopancreatic diversion; DS = duodenal switch; GERD = gastroesophageal reflux disease; GI = gastrointestinal; IM = intramuscular; IU = international units; IV = intravenous; LAGB = laparoscopic adjustable gastric band; NSAIDs = nonsteroidal anti-inflammatory drugs; PPI = proton pump inhibitor; RYGB = Roux-en-Y gastric bypass.
0, rare; +, occasional; ++, frequent.