Bariatric surgery: Indications and complications

Bariatric surgery has become a mainstay in the treatment armamentarium of morbid obesity. Randomized trials have established the efficacy of bariatric surgery towards sustained weight loss, along with significant improvements in related comorbidities, quality of life measures, and all-cause mortality. The most commonly performed and effective procedures include the Laparoscopic Roux-en-Y gastric bypass (LRYGBP), Laparoscopic adjustable gastric banding (LAGB), and Laparoscopic sleeve gastrectomy (LSG). Minimally invasive approaches have become the standard of care as they are associated with smaller incisions, less post-operative pain, fewer respiratory complications, and fewer wound complications. As with any complex surgical procedure, there are significant complications associated with these operations, including incisional hernias, deep vein thromboses, pulmonary emboli, wound infections, anastomotic leaks, bleeding, and intestinal obstruction. Procedure-specific complications include band slippage, band erosion, internal hernias, dumping syndrome, vitamin deficiencies, marginal ulcers, strictures, and esophageal reflux. Post-operative care in patients with failure of the initial procedure or with complications is challenging and may necessitate revision and reoperation. We present a brief review of bariatric surgical procedures, discussion of potential complications, and accepted management of these complications.