Peculiarities of the diagnostics and therapeutic tactics for early postoperative period bleeding after bariatric surgeries

BACKGROUND: In patients with excessive body weight the diagnosis of complications, in particular, bleeding, at an early follow-up is extremely difficult due to the non-specificity of symptoms and clinical picture. This leads to the late detection and severe expensive multi-stage treatment in patients with initially expressed comorbid pathology.

AIM: to investigate a possibility of improving the diagnosis and therapeutic tactics in morbidly obese patients in case of internal bleeding in the early postoperative period.

METHODS: We have retrospectively analyzed the results of the diagnostics and treatment of 14 patients who had internal bleeding in the early postoperative period after bariatric surgeries. The following parameters were examined: age and sex of the patients, average body mass index, comorbidities, volume of the performed bariatric surgery, type of internal bleeding (intraluminal/intra-abdominal), technical peculiarities of each operation, average postoperative stay, efficiency of instrumental diagnostic methods, types and methods of hemostasis.

RESULTS: Clinical manifestations of bleeding in all the patients operated on for morbid obesity were detected on postoperative days 1–2. The main symptoms included: weakness and dizziness — in 12 cases (86%), blood pressure decrease to 90/60 mmHg — in 4 cases (29%), tachycardia (heart rate of 100 bpm and more) — in 100% of cases. The development of melena and vomiting with blood admixture was noted in 6 cases (43%), blood flow by drainage — in 8 patients (57%). In 4 patients (29%) the bleeding onset was preceded by a blood pressure increase up to (180–200)/(100–110) mmHg. In all 14 patients the hemoglobin level was decreased: in 6 patients (43%) it was not lower than 100 g/L (but decreased by more than 20% from the initial hemoglobin level), and in 8 patients (57%) it dropped below 100 g/L. Esophagogastroduodenoscopy was used to diagnose the bleeding inside the lumen of the stomach, intestine, anastomosis, and computerized tomography of the abdominal cavity with an intravenous and oral contrast was used for diagnosing the intra-abdominal bleeding. In 6 patients with intra-abdominal bleeding, a revision laparoscopy was performed as an emergency procedure. When the source of bleeding from the stapler line was revealed, the bleeding zone was additionally sutured with a Vicryl 3/0 thread using separate knotted sutures. In case of bleeding from the trocar wound, the hemostasis was performed with a Bersi needle using a 1/0 capron thread. No lethal outcomes were observed. All the patients were discharged in a satisfactory condition. The average hospital stay was increased by 2–3 days due to the complication.

CONCLUSION: The effective methods for the diagnostics and treatment of the intraluminal bleeding are endoscopic techniques with the possibility of reliable hemostasis. In case of the intra-abdominal bleeding, relaparoscopy with stitching or clipping of the bleeding source is indicated.