The Incidence and Management of Post-operative Hemorrhage After Laparoscopic Gastric Bypass

Background: Management and prevention of post-operative hemorrhage after laparoscopic gastric bypass (LGB) has been debated. Some authors believe in routine use of staple line buttress materials and the philosophy of routine re-operation for post-operative hemorrhage.
Methods: A retrospective, multi-institutional review of all patients having undergone a LGB (without staple line reinforcement) was undertaken to identify patients with peri-operative bleeding. Hemorrhage was defined as necessitating transfusion for hemodynamic instability.
Results: 33 of 3054 (1.1%) LGB patients were identified to have hemorrhage requiring transfusion. 18 patients had gastrointestinal (GI) bleeding, one subcutaneous, and 15 intraperitoneal bleeding (IP). Bleeding was identified a median of 1 day post-operative (0-1). Nine patients underwent laparoscopic exploration and only two were therapeutic (both had active bleeding from mesentery). Multivariable logistic regression did not identify BMI, age, institution, race or gender as predicting post-operative bleeding. There was no significant difference in the time for presentation of symptoms of bleeding and the type of bleed. Two methods of thromboembolic prophylaxis were utilized: continuous intravenous heparin infusion, n=208, and low molecular weight heparin, n=2720. Comparing these two methods, there was no difference in bleeding risk.
Conclusion: The clinical course and management of hemorrhage was similar regardless of source. Non-operative management of bleeding with volume resuscitation is successful in most patients after LGB. The incidence of post LGB bleeding is acceptable without the use of staple line buttress materials.

Session: Podium Presentation

Program Number: S008

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