What are the complications of Roux-en-Y gastric bypass surgery?

From the Guidelines

Gastric bypass surgery can lead to several complications, including dumping syndrome, nutritional deficiencies, and gallstone formation, which can significantly impact a patient's quality of life and morbidity. The most common complication is dumping syndrome, which occurs in up to 40% of patients after Roux-en-Y gastric bypass or sleeve gastrectomy 1. Dumping syndrome is characterized by early and late symptoms, including gastrointestinal symptoms such as abdominal pain, bloating, and diarrhea, as well as vasomotor symptoms like fatigue, flushing, and palpitations 1.

Some of the key complications of Roux-en-Y gastric bypass surgery include:

• Dumping syndrome, which can be managed with dietary changes, such as eating smaller meals, avoiding sugary foods, and drinking slowly 1
• Nutritional deficiencies, particularly in vitamin B12, iron, calcium, and vitamin D, which require lifelong supplementation with multivitamins, calcium citrate, and vitamin D 1
• Gallstone formation, which affects about 30% of patients due to rapid weight loss, and can be managed with a low-fat diet and regular exercise 1
• Internal hernias, which can occur when intestines slip through spaces created during surgery, potentially causing bowel obstruction requiring emergency surgery
• Hypoglycemia, which may develop years after surgery due to altered insulin response
• Excess skin following rapid weight loss, which often requires additional plastic surgery procedures
• Psychological issues like depression, relationship changes, and transfer addiction, which may also emerge

Regular follow-up with healthcare providers is essential to monitor and address these potential complications, and to ensure that patients are receiving adequate supplementation and dietary guidance to prevent long-term morbidity and mortality. According to the most recent guidelines, patients should be advised to take high-potency multivitamins, calcium citrate, and vitamin D supplements, and to eat multiple small meals throughout the day to manage dumping syndrome and prevent nutritional deficiencies 1. Additionally, patients should be screened for gallstones, internal hernias, and hypoglycemia, and should be monitored for signs of psychological distress or transfer addiction.

From the Research

Complications of Roux-en-Y Gastric Bypass Surgery

The complications of Roux-en-Y gastric bypass surgery can be divided into two groups: early and late complications.

• Early complications include:
  • Anastomotic or staple line leaks 2
  • Gastrointestinal bleeding 2
  • Intestinal obstruction 2
  • Incorrect Roux limb reconstruction 2
• Late complications include:
  • Anastomotic strictures 3
  • Marginal ulceration 3
  • Gastrogastric fistula 3

Nutritional Complications

Roux-en-Y gastric bypass surgery is also associated with nutritional complications, including:

• Vitamin deficiencies, such as beriberi 4
• Micronutrient deficiencies, including deficiencies in calcium, magnesium, folate, and vitamins A, B1, and B6 5
• Anemia and iron deficiency 5
• Vitamin B12 deficiency 5
• Vitamin D deficiency, which is the most common preoperative deficiency 5

Risk Factors for Complications

Several risk factors have been identified for early postoperative complications after bariatric surgery, including:

• Male gender 6
• Open and revisional surgery 6
• Hypertension 6
• Hypoalbuminemia 6
• Previous abdominal surgery, which is a predictor of severe complication after laparoscopic primary Roux-en-Y gastric bypass 6