Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Bariatric operative procedures: Thirty-day morbidity and mortality

Robert B Lim, MD, FACS, COL, MC, USA
Section Editor
Daniel Jones, MD
Deputy Editor
Wenliang Chen, MD, PhD


Early morbidity and mortality rates that occur ≤30 days after the operation are generally low and vary with surgical approach, such as fewer complications and less mortality with the laparoscopic than the open approach [1,2]. Most patients have been discharged from the hospital during this one-month interval after the operation [2]. In addition, the occurrence of an adverse intraoperative event (AIE) also increases the risk of a serious postoperative complication [3].

This topic will review the early (≤30-day) serious postoperative complications that can occur after hospital discharge of the more common bariatric surgical procedures, including laparoscopic Roux-en-Y gastric bypass (LRYGB) and open Roux-en-Y gastric bypass (ORYGB), laparoscopic adjustable gastric band (LAGB), laparoscopic sleeve gastrectomy (LSG), and biliopancreatic diversion with duodenal switch (BPD-DS).

A description of bariatric procedures, indications and preoperative management, and intraoperative and in-hospital complications are reviewed as separate topics.

(See "Bariatric procedures for the management of severe obesity: Descriptions".)

(See "Bariatric operations for management of obesity: Indications and preoperative preparation".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Sep 2017. | This topic last updated: May 16, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Lancaster RT, Hutter MM. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc 2008; 22:2554.
  2. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, Flum DR, Belle SH, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 2009; 361:445.
  3. Stenberg E, Szabo E, Agren G, et al. Early complications after laparoscopic gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry. Ann Surg 2014; 260:1040.
  4. Masoomi H, Nguyen NT, Stamos MJ, Smith BR. Overview of outcomes of laparoscopic and open Roux-en-Y gastric bypass in the United States. Surg Technol Int 2012; 22:72.
  5. Nelson DW, Blair KS, Martin MJ. Analysis of obesity-related outcomes and bariatric failure rates with the duodenal switch vs gastric bypass for morbid obesity. Arch Surg 2012; 147:847.
  6. Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 2001; 234:279.
  7. Nguyen NT, Ho HS, Palmer LS, Wolfe BM. A comparison study of laparoscopic versus open gastric bypass for morbid obesity. J Am Coll Surg 2000; 191:149.
  8. Leivonen MK, Juuti A, Jaser N, Mustonen H. Laparoscopic sleeve gastrectomy in patients over 59 years: early recovery and 12-month follow-up. Obes Surg 2011; 21:1180.
  9. Topart P, Becouarn G, Ritz P. Comparative early outcomes of three laparoscopic bariatric procedures: sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis 2012; 8:250.
  10. Kehagias I, Karamanakos SN, Argentou M, Kalfarentzos F. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2. Obes Surg 2011; 21:1650.
  11. Skrekas G, Antiochos K, Stafyla VK. Laparoscopic gastric greater curvature plication: results and complications in a series of 135 patients. Obes Surg 2011; 21:1657.
  12. Jacobs M, Bisland W, Gomez E, et al. Laparoscopic sleeve gastrectomy: a retrospective review of 1- and 2-year results. Surg Endosc 2010; 24:781.
  13. Menenakos E, Stamou KM, Albanopoulos K, et al. Laparoscopic sleeve gastrectomy performed with intent to treat morbid obesity: a prospective single-center study of 261 patients with a median follow-up of 1 year. Obes Surg 2010; 20:276.
  14. Chen SY, Stem M, Schweitzer MA, et al. Assessment of postdischarge complications after bariatric surgery: A National Surgical Quality Improvement Program analysis. Surgery 2015; 158:777.
  15. Carlin AM, Zeni TM, English WJ, et al. The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity. Ann Surg 2013; 257:791.
  16. Smith MD, Adeniji A, Wahed AS, et al. Technical factors associated with anastomotic leak after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2015; 11:313.
  17. Padua R, Geiger JD, Dambock S, Nagy JI. 2'-Deoxycoformycin inhibition of adenosine deaminase in rat brain: in vivo and in vitro analysis of specificity, potency, and enzyme recovery. J Neurochem 1990; 54:1169.
  18. Hedberg J, Sundström J, Sundbom M. Duodenal switch versus Roux-en-Y gastric bypass for morbid obesity: systematic review and meta-analysis of weight results, diabetes resolution and early complications in single-centre comparisons. Obes Rev 2014; 15:555.
  19. Souto-Rodríguez R, Alvarez-Sánchez MV. Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results. World J Gastrointest Endosc 2017; 9:105.
  20. Csendes A, Burgos AM, Altuve J, Bonacic S. Incidence of marginal ulcer 1 month and 1 to 2 years after gastric bypass: a prospective consecutive endoscopic evaluation of 442 patients with morbid obesity. Obes Surg 2009; 19:135.
  21. Hess DS, Hess DW, Oakley RS. The biliopancreatic diversion with the duodenal switch: results beyond 10 years. Obes Surg 2005; 15:408.
  22. Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion: two decades of experience. In: Update: Surgery for the Morbidly Obese Patient, Deitel M, Cowan GSM (Eds), FD-Communications, Toronto 2000. p.227.
  23. Azagury DE, Abu Dayyeh BK, Greenwalt IT, Thompson CC. Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes. Endoscopy 2011; 43:950.
  24. Parikh A, Alley JB, Peterson RM, et al. Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. Surg Endosc 2012; 26:738.
  25. Gravante G, Araco A, Araco F, et al. Laparoscopic adjustable gastric bandings: a prospective randomized study of 400 operations performed with 2 different devices. Arch Surg 2007; 142:958.
  26. Spivak H, Favretti F. Avoiding postoperative complications with the LAP-BAND system. Am J Surg 2002; 184:31S.
  27. Gagner M, Gentileschi P, de Csepel J, et al. Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg 2002; 12:254.
  28. Shen R, Ren CJ. Removal of peri-gastric fat prevents acute obstruction after Lap-Band surgery. Obes Surg 2004; 14:224.
  29. Shimizu H, Maia M, Kroh M, et al. Surgical management of early small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2013; 9:718.
  30. Jones KB Jr, Afram JD, Benotti PN, et al. Open versus laparoscopic Roux-en-Y gastric bypass: a comparative study of over 25,000 open cases and the major laparoscopic bariatric reported series. Obes Surg 2006; 16:721.
  31. Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg 2003; 138:957.
  32. Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg 2003; 13:350.
  33. Ximenes MA, Baroni RH, Trindade RM, et al. Petersen's hernia as a complication of bariatric surgery: CT findings. Abdom Imaging 2011; 36:126.
  34. Berger ER, Huffman KM, Fraker T, et al. Prevalence and Risk Factors for Bariatric Surgery Readmissions: Findings From 130,007 Admissions in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Ann Surg 2016.
  35. Winegar DA, Sherif B, Pate V, DeMaria EJ. Venous thromboembolism after bariatric surgery performed by Bariatric Surgery Center of Excellence Participants: analysis of the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis 2011; 7:181.
  36. Gupta PK, Gupta H, Kaushik M, et al. Predictors of pulmonary complications after bariatric surgery. Surg Obes Relat Dis 2012; 8:574.
  37. Arterburn D, Livingston EH, Schifftner T, et al. Predictors of long-term mortality after bariatric surgery performed in Veterans Affairs medical centers. Arch Surg 2009; 144:914.
  38. Stephens DJ, Saunders JK, Belsley S, et al. Short-term outcomes for super-super obese (BMI > or =60 kg/m2) patients undergoing weight loss surgery at a high-volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and open tubular gastric bypass. Surg Obes Relat Dis 2008; 4:408.
  39. Ballantyne GH, Svahn J, Capella RF, et al. Predictors of prolonged hospital stay following open and laparoscopic gastric bypass for morbid obesity: body mass index, length of surgery, sleep apnea, asthma, and the metabolic syndrome. Obes Surg 2004; 14:1042.
  40. Tiwari MM, Goede MR, Reynoso JF, et al. Differences in outcomes of laparoscopic gastric bypass. Surg Obes Relat Dis 2011; 7:277.
  41. Cawley J, Sweeney MJ, Kurian M, et al. Predicting complications after bariatric surgery using obesity-related co-morbidities. Obes Surg 2007; 17:1451.
  42. Masoomi H, Reavis KM, Smith BR, et al. Risk factors for acute respiratory failure in bariatric surgery: data from the Nationwide Inpatient Sample, 2006-2008. Surg Obes Relat Dis 2013; 9:277.
  43. Helmiö M, Victorzon M, Ovaska J, et al. SLEEVEPASS: a randomized prospective multicenter study comparing laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: preliminary results. Surg Endosc 2012; 26:2521.
  44. Jones SB, Jones DB. Obesity Surgery: Patient Safety and Best Practices, Ciné-Med, Inc., Woodbury, CT 2008.
  45. Gagner M, Deitel M, Kalberer TL, et al. The Second International Consensus Summit for Sleeve Gastrectomy, March 19-21, 2009. Surg Obes Relat Dis 2009; 5:476.
  46. Lalor PF, Tucker ON, Szomstein S, Rosenthal RJ. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2008; 4:33.
  47. Moon Han S, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg 2005; 15:1469.
  48. Himpens J, Dapri G, Cadière GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 2006; 16:1450.
  49. Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg 2006; 16:1138.
  50. Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc 2007; 21:1810.
  51. Hamoui N, Anthone GJ, Kaufman HS, Crookes PF. Sleeve gastrectomy in the high-risk patient. Obes Surg 2006; 16:1445.
  52. Armstrong J, O'Malley SP. Outcomes of sleeve gastrectomy for morbid obesity: a safe and effective procedure? Int J Surg 2010; 8:69.
  53. Trelles, N, Gagner, M. Sleeve gastrectomy. Operative Techniques in General Surgery 2007; 9:123.
  54. Van Nieuwenhove Y, Dambrauskas Z, Campillo-Soto A, et al. Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: a randomized multicenter study. Arch Surg 2011; 146:1300.
  55. Cassie S, Menezes C, Birch DW, et al. Effect of preoperative weight loss in bariatric surgical patients: a systematic review. Surg Obes Relat Dis 2011; 7:760.
  56. Varadhan KK, Neal KR, Dejong CH, et al. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 2010; 29:434.
  57. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2011; :CD007635.
  58. Lemanu DP, Singh PP, Berridge K, et al. Randomized clinical trial of enhanced recovery versus standard care after laparoscopic sleeve gastrectomy. Br J Surg 2013; 100:482.
  59. Awad S, Carter S, Purkayastha S, et al. Enhanced recovery after bariatric surgery (ERABS): clinical outcomes from a tertiary referral bariatric centre. Obes Surg 2014; 24:753.
  60. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 292:1724.
  61. Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med 2005; 142:547.
  62. Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA 2005; 294:1909.
  63. Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery 2007; 142:621.
  64. DeMaria EJ, Pate V, Warthen M, Winegar DA. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis 2010; 6:347.
  65. Dimick JB, Welch HG, Birkmeyer JD. Surgical mortality as an indicator of hospital quality: the problem with small sample size. JAMA 2004; 292:847.
  66. Ballantyne GH, Belsley S, Stephens D, et al. Bariatric surgery: low mortality at a high-volume center. Obes Surg 2008; 18:660.
  67. Flum DR, Salem L, Elrod JA, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA 2005; 294:1903.
  68. Smith FJ, Holman CD, Moorin RE, Fletcher DR. Incidence of bariatric surgery and postoperative outcomes: a population-based analysis in Western Australia. Med J Aust 2008; 189:198.
  69. Smith MD, Patterson E, Wahed AS, et al. Thirty-day mortality after bariatric surgery: independently adjudicated causes of death in the longitudinal assessment of bariatric surgery. Obes Surg 2011; 21:1687.
  70. Chapman A, Kiroff G, Game P, et al.. Systematic review of laparoscopic adjustable gastric banding in the treatment of obesity: Update & Re-appraisal, Australian Safety & Efficacy Register of New Interventional Procedures - Surgical, 2002.
  71. Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg 2014; 149:275.
  72. DeMaria EJ, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis 2007; 3:134.
  73. DeMaria EJ, Murr M, Byrne TK, et al. Validation of the obesity surgery mortality risk score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity. Ann Surg 2007; 246:578.
  74. Brolin RE, Cody RP, Marcella SW. Differences in open versus laparoscopic gastric bypass mortality risk using the Obesity Surgery Mortality Risk Score (OS-MRS). Surg Obes Relat Dis 2015; 11:1201.
  75. Owers CE, Abbas Y, Ackroyd R, et al. Perioperative optimization of patients undergoing bariatric surgery. J Obes 2012; 2012:781546.
  76. Mason EE, Renquist KE, Huang YH, et al. Causes of 30-day bariatric surgery mortality: with emphasis on bypass obstruction. Obes Surg 2007; 17:9.
  77. Melinek J, Livingston E, Cortina G, Fishbein MC. Autopsy findings following gastric bypass surgery for morbid obesity. Arch Pathol Lab Med 2002; 126:1091.
  78. Gagner M, Milone L, Yung E, et al. Causes of early mortality after laparoscopic adjustable gastric banding. J Am Coll Surg 2008; 206:664.
  79. Nguyen NT, Masoomi H, Laugenour K, et al. Predictive factors of mortality in bariatric surgery: data from the Nationwide Inpatient Sample. Surgery 2011; 150:347.
  80. Livingston EH, Langert J. The impact of age and Medicare status on bariatric surgical outcomes. Arch Surg 2006; 141:1115.
  81. Hollenbeak CS, Rogers AM, Barrus B, et al. Surgical volume impacts bariatric surgery mortality: a case for centers of excellence. Surgery 2008; 144:736.
  82. Fan VS, Maciejewski ML, Liu C, et al. Comparison of risk adjustment measures based on self-report, administrative data, and pharmacy records to predict clinical outcomes. Health Serv Outcomes Res Methodol 2006; 6:21.
  83. Pope GC, Kautter J, Ellis RP, et al. Risk adjustment of Medicare capitation payments using the CMS-HCC model. Health Care Financ Rev 2004; 25:119.
  84. Maciejewski ML, Liu CF, Derleth A, et al. The performance of administrative and self-reported measures for risk adjustment of Veterans Affairs expenditures. Health Serv Res 2005; 40:887.
  85. Gonzalez R, Murr MM. Anastomotic leaks following gastric bypass surgery. In: Weight Loss Surgery: A Multidisciplinary Approach, Rosenthal RJ, Jones DB (Eds), Matrix Medical Communications, Edgemont, PA 2008. p.369.
  86. Inabnet WB 3rd, Winegar DA, Sherif B, Sarr MG. Early outcomes of bariatric surgery in patients with metabolic syndrome: an analysis of the bariatric outcomes longitudinal database. J Am Coll Surg 2012; 214:550.
  87. Varela JE, Hinojosa MW, Nguyen NT. Bariatric surgery outcomes in morbidly obese with the metabolic syndrome at US academic centers. Obes Surg 2008; 18:1273.
  88. Mosko JD, Nguyen GC. Increased perioperative mortality following bariatric surgery among patients with cirrhosis. Clin Gastroenterol Hepatol 2011; 9:897.
  89. Khan MA, Grinberg R, Johnson S, et al. Perioperative risk factors for 30-day mortality after bariatric surgery: is functional status important? Surg Endosc 2013; 27:1772.
  90. https://www.facs.org/~/media/files/quality%20programs/bariatric/mbsaqip%20standardsmanual.ashx (Accessed on May 16, 2017).
  91. Mohr CJ, Nadzam GS, Curet MJ. Totally robotic Roux-en-Y gastric bypass. Arch Surg 2005; 140:779.
  92. Mohr CJ, Nadzam GS, Alami RS, et al. Totally robotic laparoscopic Roux-en-Y Gastric bypass: results from 75 patients. Obes Surg 2006; 16:690.
  93. Sanchez BR, Mohr CJ, Morton JM, et al. Comparison of totally robotic laparoscopic Roux-en-Y gastric bypass and traditional laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2005; 1:549.
  94. Smith MD, Patterson E, Wahed AS, et al. Relationship between surgeon volume and adverse outcomes after RYGB in Longitudinal Assessment of Bariatric Surgery (LABS) study. Surg Obes Relat Dis 2010; 6:118.
  95. Novitsky YW, Litwin DE, Callery MP. The net immunologic advantage of laparoscopic surgery. Surg Endosc 2004; 18:1411.
  96. Greenstein AJ, Wahed AS, Adeniji A, et al. Prevalence of adverse intraoperative events during obesity surgery and their sequelae. J Am Coll Surg 2012; 215:271.
  97. Powers KA, Rehrig ST, Jones DB. Financial impact of obesity and bariatric surgery. Med Clin North Am 2007; 91:321.
  98. Saunders JK, Ballantyne GH, Belsley S, et al. 30-day readmission rates at a high volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass. Obes Surg 2007; 17:1171.
  99. Pratt GM, Learn CA, Hughes GD, et al. Demographics and outcomes at American Society for Metabolic and Bariatric Surgery Centers of Excellence. Surg Endosc 2009; 23:795.