Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal.
Surgery Department, São João University Medical Center, Porto, Portugal.
Obes Surg. 2022 Jun;32(6):1902-1908. doi: 10.1007/s11695-022-05973-6. Epub 2022 Feb 24.
Early postoperative bleeding is a common complication after laparoscopic Roux-en-Y gastric bypass (LRYGB) and is associated with significant morbidity. We aimed to identify predictors of early postoperative bleeding after LRYGB and characterize hemorrhagic events and 30-day postoperative outcomes.
We conducted a retrospective cohort study regarding all patients submitted to LRYGB in 2019 at a high-volume obesity center. Early postoperative bleeding was defined as any clinically significant evidence of hemorrhage in the early postoperative period. Demographic, preoperative, and intraoperative factors were evaluated for associations with postoperative bleeding. Postoperative outcomes were compared between patients with and without hemorrhage.
Of 340 patients submitted to LRYGB, 14 (4.1%) had early postoperative bleeding. Patients with bleeding had an increased preoperative left hepatic lobe diameter (8.4 vs. 7.3 cm, p = 0.048). Prior cholecystectomy (28.6 vs. 14.5%) and previous bariatric surgery (35.7 vs. 23.9%) tended to be more prevalent among these patients. Bleeding occurred at a median time of 31.2 [IQR 19.7-38.5] h. Thirteen patients presented with intraluminal bleeding and one with extraluminal bleeding. Melena was the most common symptom. All hemorrhages were clinically diagnosed, and 92.9% were managed conservatively. Postoperative bleeding was associated with longer hospital stay (3.5 vs. 2.0 days), higher reintervention (7.1 vs. 0%), and readmission (14.3 vs. 0%), all p < 0.05.
Bleeding was the most frequent early complication after LRYGB. Patients with hepatomegaly and prior surgeries may have technically challenging LRYGB and should be carefully assessed. Perioperative strategies should be encouraged in high-risk patients to prevent bleeding.
腹腔镜 Roux-en-Y 胃旁路术（LRYGB）后早期术后出血是一种常见的并发症，与显著的发病率相关。本研究旨在确定 LRYGB 后早期术后出血的预测因素，并对出血事件和 30 天术后结局进行特征描述。
我们对 2019 年在一家高容量肥胖中心接受 LRYGB 的所有患者进行了回顾性队列研究。早期术后出血定义为术后早期任何有临床意义的出血证据。评估了人口统计学、术前和术中因素与术后出血的关系。比较了有出血和无出血患者的术后结局。
在 340 例接受 LRYGB 的患者中，有 14 例（4.1%）发生早期术后出血。有出血的患者术前左肝叶直径增大（8.4cm 比 7.3cm，p=0.048）。这些患者中胆囊切除术（28.6%比 14.5%）和既往减重手术（35.7%比 23.9%）更为常见。出血发生的中位时间为 31.2[IQR 19.7-38.5]h。13 例患者表现为管腔内出血，1 例表现为管腔外出血。黑便为最常见的症状。所有出血均经临床诊断，92.9%患者采用保守治疗。术后出血与住院时间延长（3.5 天比 2.0 天）、再干预率增加（7.1%比 0%）和再入院率增加（14.3%比 0%）相关，所有差异均有统计学意义（p<0.05）。
出血是 LRYGB 后最常见的早期并发症。肝肿大和既往手术的患者可能具有技术挑战性的 LRYGB，应仔细评估。应鼓励高危患者采取围手术期策略以预防出血。
