Mistakes in bariatric surgery and how to avoid them

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Mistakes in bariatric surgery and how to avoid them

Francesco Saverio Papadia, Gianni Camerini

Summary

AI Generated

This material discusses common mistakes in managing bariatric surgery patients across preoperative, perioperative, and postoperative periods, acknowledging that high-level evidence is lacking for many aspects of surgical bariatric care.

Bariatric surgery is accepted as a safe and effective treatment for morbid obesity and has gained widespread popularity over the past two decades.
Advancements in surgical techniques, perioperative care, and fellowship-based training have substantially reduced morbidity and mortality rates.
Several controversial aspects of surgical treatments for morbidly obese patients remain to be considered.
The discussion is based on clinical experience rather than high-level evidence, which is lacking for many aspects of surgical bariatric care.
This content would benefit clinicians involved in the care of bariatric surgery candidates and postoperative patients.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6

Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. The Lancet. 2016;387(10026):1377-96. [Link]

Braghetto I, et al. Prevalence of Barrett’s esophagus in bariatric patients undergoing sleeve gastrectomy. Obes Surg 2016;26(4):710–4. [Link]

Felsenreich DM, Kefurt R, et al. Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: longterm follow-up. Obes Surg 2017;27(12):3092–101. [Link]

Genco A, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis 2017;13(4):568–74. [Link]

Papadia FS, et al. Sleeve gastrectomy may double the risk of esophageal adenocarcinoma in morbidly obese patients. Surg Obes Relat Dis. 2021 May;17(5):1029-1030. [Link]

El Khoury L, et al. Esophageal adenocarcinoma in Barrett’s esophagus after sleeve gastrectomy: case report and literature review. Int J Surg Case Rep 2018;52:132–6. [Link]

Campos GM, et al; Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery. ASMBS position statement on the rationale for performance of upper gastrointestinal endoscopy before and after metabolic and bariatric surgery. Surg Obes Relat Dis. 2021 May;17(5):837-847. [Link]

Yeung KTD, et al. Does sleeve gastrectomy expose the distal esophagus to severe reflux? A systematic review and meta-analysis. Ann Surg 2020;271(2):257–65. [Link]

Aronson S, et al. Preoperative optimization: a continued call to action. Anesth Analg 2020;130(4):808–10. [Link]

10.

Haskins IN, et al. The effect of smoking on bariatric surgical outcomes. Surg Endosc 2014;28(11):3074–80. [Link]

11.

Di Palma A, et al. Marginal ulceration following Roux-en-Y gastric bypass: risk factors for ulcer development, recurrence and need for revisional surgery. Surg Endosc 2021;35(5):2347–53. [Link]

12.

Kim JJ, et al. ASMBS updated position statement on insurance mandated preoperative weight loss requirements. Surg Obes Relat Dis 2016;12(5):955–9. [Link]

13.

Edholm D, et al. Preoperative 4-week low calorie diet reduces liver volume and intrahepatic fat and facilitates laparoscopic gastric bypass in morbidly obese. Obes Surg 2011;21(3):345–50. [Link]

14.

Sivakumar J, et al. Body composition changes following a very-low-calorie pre-operative diet in patients undergoing bariatric surgery. Obes Surg 2020;30(1):119–26. [Link]

15.

Tashiro T, et al. Perioperative risk of major non-cardiac surgery in patients with severe aortic stenosis: a reappraisal in contemporary practice. Eur Heart J 2014;35(35):2372–81. [Link]

16.

Sogg S, et al. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. Surg Obes Relat Dis 2016;12(4):731–49. [Link]

17.

Spight DH, et al. Minimally invasive surgery, robotics natural orifice transluminal endoscopic surgery, and single incision laparoscopic surgery. In Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE “Schwartz’s Principles of Surgery”, 10th Edition, McGraw Hill Eds, ISBN0071796754; p. 424-425 [Link]

18.

Clapp B. Optimal Initial Trocar Placement for Morbidly Obese Patients. JSLS. 2018 Oct-Dec;22(4):e2017.00101. [Link]

19.

Kassir R, et al. Complications of Bariatric Surgery: Presentation and Emergency Management. Int J Surg 2016; 27: 77-81. [Link]

20.

Gonzalez R, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg 2007;204(1):47–55 [Link]

21.

Levine MS, et al. Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology 2014;270(2): 327–341. [Link]

22.

Csendes A, et al. Classification and management of leaks after gastric bypass for patients with morbid obesity: a prospective study of 60 patients. Obes Surg. 2012 Jun;22(6):855-62. [Link]

23.

Camerini G, et al. Radiology of patients with vertical banded gastroplasty. Obes Surg. 2002 Feb;12(1):57-61. [Link]

24.

Sakran N, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc 2013;27(1):240–5. [Link]

25.

Rosenthal RJ, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis 2012;8(1):8–19. [Link]

26.

Iannelli A, et al. Laparoscopic roux limb placement over a fistula defect without mucosa-to-mucosa anastomosis: a modified technique for surgical management of chronic proximal fistulas after laparoscopic sleeve gastrectomy. Obes Surg 2014;24(5):825–8. [Link]

27.

Nedelcu AM, et al. Surgical management of chronic fistula after sleeve gastrectomy. Surg Obes Relat Dis 2013;9(6):879–84. [Link]

28.

García Ruiz de Gordejuela A, et al. Evaluation of bariatric surgery patients at the emergency department of a tertiary referral hospital. Rev Esp Enferm Dig. 2015; 107(1): 23–8. [Link]

29.

Petrucciani N, et al. Internal Hernia After One Anastomosis Gastric Bypass (OAGB): Lessons Learned from a Retrospective Series of 3368 Consecutive Patients Undergoing OAGB with a Biliopancreatic Limb of 150 cm. Obes Surg. 2021 Jun;31(6):2537-2544. [Link]

30.

Geubbels N, et al. Meta-analysis of internal herniation after gastric bypass surgery. Br J Surg. 2015 Apr;102(5):451-60. [Link]

31.

Spector D, et al. Roux-en-Y gastric bypass: hyperamylasemia is associated with small bowel obstruction. Surg Obes Relat Dis. 2015;11(1):38–43 [Link]

32.

Lockhart ME, et al. Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR Am J Roentgenol. 2007 Mar;188(3):745-50. [Link]

33.

Altinoz A, et al. Diagnostic laparoscopy is more accurate than Computerized Tomography for internal hernia after Roux-en-Y gastric bypass. Am J Surg. 2020 Jul;220(1):214-216. [Link]

34.

Nimeri AA, et al. Internal Hernia Following Laparoscopic Roux-en-Y Gastric Bypass: Prevention and Tips for Intra-operative Management. Obes Surg. 2016 Sep;26(9):2255-2256. [Link]

35.

Bal BS, et al. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol 2012;8(9):544–56. [Link]

36.

Botella-Carretero JI, et al. Serum bioavailable vitamin D concentrations and bone mineral density in women after obesity surgery. Obes Surg 2016;26(11):2732–7. [Link]

37.

Aasheim ET. Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg. 2008 Nov;248(5):714-20. [Link]

38.

Hari T, et al. Bariatric surgery-what the ophthalmologist needs to know. Eye (Lond). 2021 Oct 21:1–7. {Hari, 2021 #14}. [Link]

39.

Oudman E, et al. Preventing Wernicke Encephalopathy After Bariatric Surgery. Obes Surg. 2018 Jul;28(7):2060-2068. [Link]

Abstract

Nowadays, obesity represents an immense burden for global healthcare. The number of overweight or obese cases has exceeded that of underweight individuals.1 Bariatric surgery is accepted as a safe and effective treatment for patients with morbid obesity and has gained widespread popularity in the past two decades. Advancements in surgical techniques, perioperative care, and fellowship-based bariatric surgery training have substantially reduced morbidity and mortality rates. Nevertheless, several controversial aspects of surgical treatments of morbidly obese patients are still to be considered. Here we discuss the mistakes made when managing patients who are candidates for or have been submitted to bariatric surgery in the preoperative, perioperative, and postoperative periods. As high-level evidence is lacking for many aspects of surgical bariatric care, the discussion is based on our long-standing clinical experience.

Topics

Primary Care Small Intestine & Nutrition Surgery

Citation

Papadia Saverio F and Camerini G. Mistakes in bariatric surgery and how to avoid them. UEG Education 2022; 22: 11–15.

Published

2022

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6

Braghetto I, et al. Prevalence of Barrett’s esophagus in bariatric patients undergoing sleeve gastrectomy. Obes Surg 2016;26(4):710–4. [Link]

Felsenreich DM, Kefurt R, et al. Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: longterm follow-up. Obes Surg 2017;27(12):3092–101. [Link]

Papadia FS, et al. Sleeve gastrectomy may double the risk of esophageal adenocarcinoma in morbidly obese patients. Surg Obes Relat Dis. 2021 May;17(5):1029-1030. [Link]

El Khoury L, et al. Esophageal adenocarcinoma in Barrett’s esophagus after sleeve gastrectomy: case report and literature review. Int J Surg Case Rep 2018;52:132–6. [Link]

Yeung KTD, et al. Does sleeve gastrectomy expose the distal esophagus to severe reflux? A systematic review and meta-analysis. Ann Surg 2020;271(2):257–65. [Link]

Aronson S, et al. Preoperative optimization: a continued call to action. Anesth Analg 2020;130(4):808–10. [Link]

10.

Haskins IN, et al. The effect of smoking on bariatric surgical outcomes. Surg Endosc 2014;28(11):3074–80. [Link]

11.

Di Palma A, et al. Marginal ulceration following Roux-en-Y gastric bypass: risk factors for ulcer development, recurrence and need for revisional surgery. Surg Endosc 2021;35(5):2347–53. [Link]

12.

Kim JJ, et al. ASMBS updated position statement on insurance mandated preoperative weight loss requirements. Surg Obes Relat Dis 2016;12(5):955–9. [Link]

13.

Edholm D, et al. Preoperative 4-week low calorie diet reduces liver volume and intrahepatic fat and facilitates laparoscopic gastric bypass in morbidly obese. Obes Surg 2011;21(3):345–50. [Link]

14.

Sivakumar J, et al. Body composition changes following a very-low-calorie pre-operative diet in patients undergoing bariatric surgery. Obes Surg 2020;30(1):119–26. [Link]

15.

Tashiro T, et al. Perioperative risk of major non-cardiac surgery in patients with severe aortic stenosis: a reappraisal in contemporary practice. Eur Heart J 2014;35(35):2372–81. [Link]

16.

Sogg S, et al. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. Surg Obes Relat Dis 2016;12(4):731–49. [Link]

17.

18.

Clapp B. Optimal Initial Trocar Placement for Morbidly Obese Patients. JSLS. 2018 Oct-Dec;22(4):e2017.00101. [Link]

19.

Kassir R, et al. Complications of Bariatric Surgery: Presentation and Emergency Management. Int J Surg 2016; 27: 77-81. [Link]

20.

Gonzalez R, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg 2007;204(1):47–55 [Link]

21.

Levine MS, et al. Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology 2014;270(2): 327–341. [Link]

22.

Csendes A, et al. Classification and management of leaks after gastric bypass for patients with morbid obesity: a prospective study of 60 patients. Obes Surg. 2012 Jun;22(6):855-62. [Link]

23.

Camerini G, et al. Radiology of patients with vertical banded gastroplasty. Obes Surg. 2002 Feb;12(1):57-61. [Link]

24.

Sakran N, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc 2013;27(1):240–5. [Link]

25.

Rosenthal RJ, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis 2012;8(1):8–19. [Link]

26.

27.

Nedelcu AM, et al. Surgical management of chronic fistula after sleeve gastrectomy. Surg Obes Relat Dis 2013;9(6):879–84. [Link]

28.

García Ruiz de Gordejuela A, et al. Evaluation of bariatric surgery patients at the emergency department of a tertiary referral hospital. Rev Esp Enferm Dig. 2015; 107(1): 23–8. [Link]

29.

30.

Geubbels N, et al. Meta-analysis of internal herniation after gastric bypass surgery. Br J Surg. 2015 Apr;102(5):451-60. [Link]

31.

Spector D, et al. Roux-en-Y gastric bypass: hyperamylasemia is associated with small bowel obstruction. Surg Obes Relat Dis. 2015;11(1):38–43 [Link]

32.

Lockhart ME, et al. Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR Am J Roentgenol. 2007 Mar;188(3):745-50. [Link]

33.

Altinoz A, et al. Diagnostic laparoscopy is more accurate than Computerized Tomography for internal hernia after Roux-en-Y gastric bypass. Am J Surg. 2020 Jul;220(1):214-216. [Link]

34.

Nimeri AA, et al. Internal Hernia Following Laparoscopic Roux-en-Y Gastric Bypass: Prevention and Tips for Intra-operative Management. Obes Surg. 2016 Sep;26(9):2255-2256. [Link]

35.

Bal BS, et al. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol 2012;8(9):544–56. [Link]

36.

Botella-Carretero JI, et al. Serum bioavailable vitamin D concentrations and bone mineral density in women after obesity surgery. Obes Surg 2016;26(11):2732–7. [Link]

37.

Aasheim ET. Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg. 2008 Nov;248(5):714-20. [Link]

38.

Hari T, et al. Bariatric surgery-what the ophthalmologist needs to know. Eye (Lond). 2021 Oct 21:1–7. {Hari, 2021 #14}. [Link]

39.

Oudman E, et al. Preventing Wernicke Encephalopathy After Bariatric Surgery. Obes Surg. 2018 Jul;28(7):2060-2068. [Link]

Abstract

Ostomy management refers to the care and maintenance of an ostomy and involves various aspects to ensure the individual’s health, comfort, and quality of life. This should involve the patient, a close support system (family and/or friends), and a healthcare team, including ostomy nurses and healthcare professionals specialising in ostomy care.

Topics

Primary Care

Published

2025

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Mistakes in coeliac disease diagnosis and how to avoid them

Roberto De Giorgio 1, Giacomo Caio 1, Umberto Volta 1

Affiliations

1 University of Bologna, Italy

Summary

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6

Braghetto I, et al. Prevalence of Barrett’s esophagus in bariatric patients undergoing sleeve gastrectomy. Obes Surg 2016;26(4):710–4. [Link]

Felsenreich DM, Kefurt R, et al. Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: longterm follow-up. Obes Surg 2017;27(12):3092–101. [Link]

Papadia FS, et al. Sleeve gastrectomy may double the risk of esophageal adenocarcinoma in morbidly obese patients. Surg Obes Relat Dis. 2021 May;17(5):1029-1030. [Link]

El Khoury L, et al. Esophageal adenocarcinoma in Barrett’s esophagus after sleeve gastrectomy: case report and literature review. Int J Surg Case Rep 2018;52:132–6. [Link]

Yeung KTD, et al. Does sleeve gastrectomy expose the distal esophagus to severe reflux? A systematic review and meta-analysis. Ann Surg 2020;271(2):257–65. [Link]

Aronson S, et al. Preoperative optimization: a continued call to action. Anesth Analg 2020;130(4):808–10. [Link]

10.

Haskins IN, et al. The effect of smoking on bariatric surgical outcomes. Surg Endosc 2014;28(11):3074–80. [Link]

11.

Di Palma A, et al. Marginal ulceration following Roux-en-Y gastric bypass: risk factors for ulcer development, recurrence and need for revisional surgery. Surg Endosc 2021;35(5):2347–53. [Link]

12.

Kim JJ, et al. ASMBS updated position statement on insurance mandated preoperative weight loss requirements. Surg Obes Relat Dis 2016;12(5):955–9. [Link]

13.

Edholm D, et al. Preoperative 4-week low calorie diet reduces liver volume and intrahepatic fat and facilitates laparoscopic gastric bypass in morbidly obese. Obes Surg 2011;21(3):345–50. [Link]

14.

Sivakumar J, et al. Body composition changes following a very-low-calorie pre-operative diet in patients undergoing bariatric surgery. Obes Surg 2020;30(1):119–26. [Link]

15.

Tashiro T, et al. Perioperative risk of major non-cardiac surgery in patients with severe aortic stenosis: a reappraisal in contemporary practice. Eur Heart J 2014;35(35):2372–81. [Link]

16.

Sogg S, et al. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. Surg Obes Relat Dis 2016;12(4):731–49. [Link]

17.

18.

Clapp B. Optimal Initial Trocar Placement for Morbidly Obese Patients. JSLS. 2018 Oct-Dec;22(4):e2017.00101. [Link]

19.

Kassir R, et al. Complications of Bariatric Surgery: Presentation and Emergency Management. Int J Surg 2016; 27: 77-81. [Link]

20.

Gonzalez R, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg 2007;204(1):47–55 [Link]

21.

Levine MS, et al. Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology 2014;270(2): 327–341. [Link]

22.

Csendes A, et al. Classification and management of leaks after gastric bypass for patients with morbid obesity: a prospective study of 60 patients. Obes Surg. 2012 Jun;22(6):855-62. [Link]

23.

Camerini G, et al. Radiology of patients with vertical banded gastroplasty. Obes Surg. 2002 Feb;12(1):57-61. [Link]

24.

Sakran N, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc 2013;27(1):240–5. [Link]

25.

Rosenthal RJ, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis 2012;8(1):8–19. [Link]

26.

27.

Nedelcu AM, et al. Surgical management of chronic fistula after sleeve gastrectomy. Surg Obes Relat Dis 2013;9(6):879–84. [Link]

28.

García Ruiz de Gordejuela A, et al. Evaluation of bariatric surgery patients at the emergency department of a tertiary referral hospital. Rev Esp Enferm Dig. 2015; 107(1): 23–8. [Link]

29.

30.

Geubbels N, et al. Meta-analysis of internal herniation after gastric bypass surgery. Br J Surg. 2015 Apr;102(5):451-60. [Link]

31.

Spector D, et al. Roux-en-Y gastric bypass: hyperamylasemia is associated with small bowel obstruction. Surg Obes Relat Dis. 2015;11(1):38–43 [Link]

32.

Lockhart ME, et al. Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR Am J Roentgenol. 2007 Mar;188(3):745-50. [Link]

33.

Altinoz A, et al. Diagnostic laparoscopy is more accurate than Computerized Tomography for internal hernia after Roux-en-Y gastric bypass. Am J Surg. 2020 Jul;220(1):214-216. [Link]

34.

Nimeri AA, et al. Internal Hernia Following Laparoscopic Roux-en-Y Gastric Bypass: Prevention and Tips for Intra-operative Management. Obes Surg. 2016 Sep;26(9):2255-2256. [Link]

35.

Bal BS, et al. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol 2012;8(9):544–56. [Link]

36.

Botella-Carretero JI, et al. Serum bioavailable vitamin D concentrations and bone mineral density in women after obesity surgery. Obes Surg 2016;26(11):2732–7. [Link]

37.

Aasheim ET. Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg. 2008 Nov;248(5):714-20. [Link]

38.

Hari T, et al. Bariatric surgery-what the ophthalmologist needs to know. Eye (Lond). 2021 Oct 21:1–7. {Hari, 2021 #14}. [Link]

39.

Oudman E, et al. Preventing Wernicke Encephalopathy After Bariatric Surgery. Obes Surg. 2018 Jul;28(7):2060-2068. [Link]

Abstract

Coeliac disease is an autoimmune disorder triggered by gluten, which activates an immune reaction against the autoantigen tissue transglutaminase (TG2) in genetically predisposed subjects. Genetic susceptibility to coeliac disease has been proven by its close linkage with major histocompatibility complex (MHC) class II human leukocyte antigen (HLA) DQ2 and DQ8 haplotypes. The identification of biomarkers for coeliac disease (e.g. endomysial antibodies [EmA] and antibodies to TG2 [anti-TG2]) has changed the epidemiology of coeliac disease from being a rare to a frequent condition, with an expected prevalence of 1% in the worldwide population. Coeliac disease can be difficult to diagnose because symptoms vary from patient to patient, and the majority of patients who have coeliac disease remain undiagnosed. Small intestinal biopsy remains the gold standard for coeliac disease diagnosis, and a delayed diagnosis in the elderly can be considered a risk factor for complications. Complicated coeliac disease is not so frequent, but for those who have it, the prognosis is very poor, with a low rate of survival after 5 years.

Topics

Small Intestine & Nutrition

Published

2024

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Summary

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Summary is not available for this content yet.

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Thanks for your feedback.

Abstract

Published

2025

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Management of duodenal adenomatosis in familial adenomatous polyposis patients

Katarzyna Pawlak 1, Elsa Soons 2

Affiliations

1 Department Gastroenterology, Endoscopy Unit, Hospital of the Ministry of Interior and Administration, Szczecin, Poland

2 Radboud University Medical Center, Nijmegen, Netherlands

Summary

AI Generated

Summary is not available for this content yet.

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Abstract

Topics

Endoscopy

Published

2021

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From Vienna to Berlin: What inspired us last year at UEG Week

Pradeep Mundre

Management of duodenal adenomatosis in familial adenomatous polyposis patients

Elsa Soons

Transitional care with Patrizia Burra & Jorge Amil Dias

Pradeep Mundre

UEG Podcast Episode

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Transitional care with Patrizia Burra & Jorge Amil Dias

Patrizia Burra, Jorge Amil Dias, Pradeep Mundre

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Abstract

Topics

Paediatrics

Published

2025

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