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Bariatric surgery: Postoperative and long-term management of the uncomplicated patient

Giselle Hamad, MD
Section Editor
Daniel Jones, MD
Deputy Editor
Wenliang Chen, MD, PhD


Obesity, a chronic illness identified in children, adolescents, and adults, has reached epidemic proportions worldwide [1-4]. In the United States alone, more than one-third of adults and 17 percent of youth are obese [5-7], and the rate of obesity has more than doubled since 1990 [8,9]. However, the United States only ranks 18th on the global scale of obesity [10].

Bariatric surgery, a commonly performed procedure in the United States [11], remains the most effective method of weight loss and can result in partial or complete resolution of multiple obesity-related comorbidities, including type 2 diabetes mellitus, hypertension, hypercholesterolemia, and obstructive sleep apnea [12].

The immediate postoperative care for the uncomplicated postsurgical patient and outpatient management of all bariatric surgical patients will be discussed in this topic. The indications and types of bariatric procedures, complications, management of complicated postoperative patients (eg, multiple or refractory comorbidities) in the intensive care unit, and outcomes are reviewed separately:

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

(See "Bariatric operations: Perioperative morbidity and mortality".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 06, 2017.
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  1. Peeters A, Barendregt JJ, Willekens F, et al. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med 2003; 138:24.
  2. Vlad I. Obesity costs UK economy 2bn pounds sterling a year. BMJ 2003; 327:1308.
  3. Duda RB, Darko R, Adanu RMK, et al. Prevalence of Obesity in an Urban West African Population: Results of the Women’s Health Study of Accra. African J Health Sciences 2007; 14:154.
  4. Bray GA, Kim KK, Wilding JPH, World Obesity Federation. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev 2017; 18:715.
  5. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA 2002; 288:1723.
  6. Balsiger BM, Murr MM, Poggio JL, Sarr MG. Bariatric surgery. Surgery for weight control in patients with morbid obesity. Med Clin North Am 2000; 84:477.
  7. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of Obesity Among Adults and Youth: United States, 2011-2014. NCHS Data Brief 2015; :1.
  8. Centers for Disease Control and Prevention (CDC). Vital signs: state-specific obesity prevalence among adults --- United States, 2009. MMWR Morb Mortal Wkly Rep 2010; 59:951.
  9. Mokdad AH, Serdula MK, Dietz WH, et al. The spread of the obesity epidemic in the United States, 1991-1998. JAMA 1999; 282:1519.
  10. Global prevalence of adult obesity - Country rankings 2010. Source: International Obesity Taskforce, International Association for the Study of Obesity www.allcountries.org/ranks/global_prevalence_of_adult_obesity.html (Accessed on September 01, 2017).
  11. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg 2013; 23:427.
  12. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 292:1724.
  13. de Raaff CAL, Gorter-Stam MAW, de Vries N, et al. Perioperative management of obstructive sleep apnea in bariatric surgery: a consensus guideline. Surg Obes Relat Dis 2017; 13:1095.
  14. Doraiswamy A, Rasmussen JJ, Pierce J, et al. The utility of routine postoperative upper GI series following laparoscopic gastric bypass. Surg Endosc 2007; 21:2159.
  15. Leslie DB, Dorman RB, Anderson J, et al. Routine upper gastrointestinal imaging is superior to clinical signs for detecting gastrojejunal leak after laparoscopic Roux-en-Y gastric bypass. J Am Coll Surg 2012; 214:208.
  16. Schiesser M, Guber J, Wildi S, et al. Utility of routine versus selective upper gastrointestinal series to detect anastomotic leaks after laparoscopic gastric bypass. Obes Surg 2011; 21:1238.
  17. Sims TL, Mullican MA, Hamilton EC, et al. Routine upper gastrointestinal Gastrografin swallow after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2003; 13:66.
  18. White S, Han SH, Lewis C, et al. Selective approach to use of upper gastroesophageal imaging study after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2008; 4:122.
  19. Sethi M, Magrath M, Somoza E, et al. The utility of radiological upper gastrointestinal series and clinical indicators in detecting leaks after laparoscopic sleeve gastrectomy: a case-controlled study. Surg Endosc 2016; 30:2266.
  20. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc 2012; 26:1509.
  21. Davidson JE, Callery C. Care of the obesity surgery patient requiring immediate-level care or intensive care. Obes Surg 2001; 11:93.
  22. Bellorin O, Abdemur A, Sucandy I, et al. Understanding the significance, reasons and patterns of abnormal vital signs after gastric bypass for morbid obesity. Obes Surg 2011; 21:707.
  23. Sherman V, Dan AG, Lord JM, et al. Complications of gastric bypass: avoiding the Roux-en-O configuration. Obes Surg 2009; 19:1190.
  24. 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.
  25. Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e227S.
  26. Barba CA, Harrington C, Loewen M. Status of venous thromboembolism prophylaxis among bariatric surgeons: have we changed our practice during the past decade? Surg Obes Relat Dis 2009; 5:352.
  27. Birkmeyer NJ, Finks JF, Carlin AM, et al. Comparative effectiveness of unfractionated and low-molecular-weight heparin for prevention of venous thromboembolism following bariatric surgery. Arch Surg 2012; 147:994.
  28. American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. ASMBS updated position statement on prophylactic measures to reduce the risk of venous thromboembolism in bariatric surgery patients. Surg Obes Relat Dis 2013; 9:493.
  29. Aminian A, Andalib A, Khorgami Z, et al. Who Should Get Extended Thromboprophylaxis After Bariatric Surgery?: A Risk Assessment Tool to Guide Indications for Post-discharge Pharmacoprophylaxis. Ann Surg 2017; 265:143.
  30. Hamad GG, Choban PS. Enoxaparin for thromboprophylaxis in morbidly obese patients undergoing bariatric surgery: findings of the prophylaxis against VTE outcomes in bariatric surgery patients receiving enoxaparin (PROBE) study. Obes Surg 2005; 15:1368.
  31. Raftopoulos I, Martindale C, Cronin A, Steinberg J. The effect of extended post-discharge chemical thromboprophylaxis on venous thromboembolism rates after bariatric surgery: a prospective comparison trial. Surg Endosc 2008; 22:2384.
  32. Sapala JA, Wood MH, Schuhknecht MP, Sapala MA. Fatal pulmonary embolism after bariatric operations for morbid obesity: a 24-year retrospective analysis. Obes Surg 2003; 13:819.
  33. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring) 2013; 21 Suppl 1:S1.
  34. Service GJ, Thompson GB, Service FJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med 2005; 353:249.
  35. Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surg Obes Relat Dis 2017; 13:727.
  36. Bloomberg RD, Fleishman A, Nalle JE, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg 2005; 15:145.
  37. Brolin RE, Leung M. Survey of vitamin and mineral supplementation after gastric bypass and biliopancreatic diversion for morbid obesity. Obes Surg 1999; 9:150.
  38. Levinson R, Silverman JB, Catella JG, et al. Pharmacotherapy prevention and management of nutritional deficiencies post Roux-en-Y gastric bypass. Obes Surg 2013; 23:992.
  39. Poitou Bernert C, Ciangura C, Coupaye M, et al. Nutritional deficiency after gastric bypass: diagnosis, prevention and treatment. Diabetes Metab 2007; 33:13.
  40. Vargas-Ruiz AG, Hernández-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2008; 18:288.
  41. Damms-Machado A, Friedrich A, Kramer KM, et al. Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg 2012; 22:881.
  42. Moore CE, Sherman V. Vitamin D supplementation efficacy: sleeve gastrectomy versus gastric bypass surgery. Obes Surg 2014; 24:2055.
  43. Vix M, Liu KH, Diana M, et al. Impact of Roux-en-Y gastric bypass versus sleeve gastrectomy on vitamin D metabolism: short-term results from a prospective randomized clinical trial. Surg Endosc 2014; 28:821.
  44. Bechtel P, Boorse R, Rovito P, et al. Warfarin users prone to coagulopathy in first 30 days after hospital discharge from gastric bypass. Obes Surg 2013; 23:1515.
  45. Coblijn UK, Lagarde SM, de Castro SM, et al. Symptomatic marginal ulcer disease after Roux-en-Y gastric bypass: incidence, risk factors and management. Obes Surg 2015; 25:805.
  46. Coblijn UK, Lagarde SM, de Castro SM, et al. The influence of prophylactic proton pump inhibitor treatment on the development of symptomatic marginal ulceration in Roux-en-Y gastric bypass patients: a historic cohort study. Surg Obes Relat Dis 2016; 12:246.
  47. Mitchell JF, Pawlicki KS. Oral solid dosage forms that should not be crushed: 1994 revision. Hosp Pharm 1994; 29:666.
  48. Colossi FG, Casagrande DS, Chatkin R, et al. Need for multivitamin use in the postoperative period of gastric bypass. Obes Surg 2008; 18:187.
  49. Kim HJ, Madan A, Fenton-Lee D. Does patient compliance with follow-up influence weight loss after gastric bypass surgery? A systematic review and meta-analysis. Obes Surg 2014; 24:647.
  50. Bird ET, Parker BD, Kim HS, Coffield KS. Caffeine ingestion and lower urinary tract symptoms in healthy volunteers. Neurourol Urodyn 2005; 24:611.
  51. Ziegler O, Sirveaux MA, Brunaud L, et al. Medical follow up after bariatric surgery: nutritional and drug issues. General recommendations for the prevention and treatment of nutritional deficiencies. Diabetes Metab 2009; 35:544.
  52. Chapman N, Hill K, Taylor S, et al. Patterns of physical activity and sedentary behavior after bariatric surgery: an observational study. Surg Obes Relat Dis 2014; 10:524.
  53. Hassannejad A, Khalaj A, Mansournia MA, et al. The Effect of Aerobic or Aerobic-Strength Exercise on Body Composition and Functional Capacity in Patients with BMI ≥35 after Bariatric Surgery: a Randomized Control Trial. Obes Surg 2017; 27:2792.
  54. Endevelt R, Ben-Assuli O, Klain E, Zelber-Sagi S. The role of dietician follow-up in the success of bariatric surgery. Surg Obes Relat Dis 2013; 9:963.
  55. Singhal R, Bryant C, Kitchen M, et al. Band slippage and erosion after laparoscopic gastric banding: a meta-analysis. Surg Endosc 2010; 24:2980.
  56. Brown WA, Egberts KJ, Franke-Richard D, et al. Erosions after laparoscopic adjustable gastric banding: diagnosis and management. Ann Surg 2013; 257:1047.
  57. Emous M, Wolffenbuttel BHR, Totté E, van Beek AP. The short- to mid-term symptom prevalence of dumping syndrome after primary gastric-bypass surgery and its impact on health-related quality of life. Surg Obes Relat Dis 2017; 13:1489.
  58. Tack J, Arts J, Caenepeel P, et al. Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol 2009; 6:583.
  59. Coblijn UK, Goucham AB, Lagarde SM, et al. Development of ulcer disease after Roux-en-Y gastric bypass, incidence, risk factors, and patient presentation: a systematic review. Obes Surg 2014; 24:299.
  60. Gumbs AA, Duffy AJ, Bell RL. Incidence and management of marginal ulceration after laparoscopic Roux-Y gastric bypass. Surg Obes Relat Dis 2006; 2:460.
  61. Shiffman ML, Sugerman HJ, Kellum JM, Moore EW. Changes in gallbladder bile composition following gallstone formation and weight reduction. Gastroenterology 1992; 103:214.
  62. Sugerman HJ, Brewer WH, Shiffman ML, et al. A multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric-bypass-induced rapid weight loss. Am J Surg 1995; 169:91.
  63. Adams LB, Chang C, Pope J, et al. Randomized, Prospective Comparison of Ursodeoxycholic Acid for the Prevention of Gallstones after Sleeve Gastrectomy. Obes Surg 2016; 26:990.
  64. Matlaga BR, Shore AD, Magnuson T, et al. Effect of gastric bypass surgery on kidney stone disease. J Urol 2009; 181:2573.
  65. Duffey BG, Alanee S, Pedro RN, et al. Hyperoxaluria is a long-term consequence of Roux-en-Y Gastric bypass: a 2-year prospective longitudinal study. J Am Coll Surg 2010; 211:8.
  66. Nasr SH, D'Agati VD, Said SM, et al. Oxalate nephropathy complicating Roux-en-Y Gastric Bypass: an underrecognized cause of irreversible renal failure. Clin J Am Soc Nephrol 2008; 3:1676.
  67. Hamad GG, Helsel JC, Perel JM, et al. The effect of gastric bypass on the pharmacokinetics of serotonin reuptake inhibitors. Am J Psychiatry 2012; 169:256.
  68. Burgos AM, Csendes A, Braghetto I. Gastric stenosis after laparoscopic sleeve gastrectomy in morbidly obese patients. Obes Surg 2013; 23:1481.
  69. Deslauriers V, Beauchamp A, Garofalo F, et al. Endoscopic management of post-laparoscopic sleeve gastrectomy stenosis. Surg Endosc 2017.
  70. Mamplekou E, Komesidou V, Bissias Ch, et al. Psychological condition and quality of life in patients with morbid obesity before and after surgical weight loss. Obes Surg 2005; 15:1177.
  71. van Hout GC, Boekestein P, Fortuin FA, et al. Psychosocial functioning following bariatric surgery. Obes Surg 2006; 16:787.
  72. Monpellier VM, Antoniou EE, Aarts EO, et al. Improvement of Health-Related Quality of Life After Roux-en-Y Gastric Bypass Related to Weight Loss. Obes Surg 2017; 27:1168.
  73. King WC, Hsu JY, Belle SH, et al. Pre- to postoperative changes in physical activity: report from the longitudinal assessment of bariatric surgery-2 (LABS-2). Surg Obes Relat Dis 2012; 8:522.