Bariatric and Metabolic Surgery by Luigi Angrisani

Author:Luigi Angrisani
Language: eng
Format: epub
Publisher: Springer Milan, Milano

10.4.1.3 10.4.1.3 Bleeding (Grades II–IV)

Postoperative bleeding ranges from 1.7% to 10% and seems to be greater following the laparoscopic procedure. However, larger laparoscopic series report a postoperative haemorrhage rate of <3% [21, 22]. Bleeding can be intraluminal (duodenoileal anastomosis, ileoileal anastomosis, SG). Clinically, patients could present with anemia, hypotension, tachycardia, hematemesis, and/or melena. Sometimes, site recognition and relative management represent a challenge. In all cases, management includes serial blood count evaluation and spiral angio-CT scan. Management differs according to bleeding timing. If it occurs in the first postoperative day and is associated with hemodynamic instability, reoperation is recommended. Endoscopy (with adrenaline injection, electrocautery, or endoclips) can be useful. If bleeding occurs after — and furthermore, in the presence of — hemodynamic stability, a conservative approach (fluid administration, blood transfusion when needed) can be adopted. Hand-sewing the duodenoileal anastomosis, using a six-rows vascular load stapler for ileoileal anastomosis, and reinforcement materials over the stapler line have proved to reduce the risk of bleeding.

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