Improving the management of morbidly obese patients with
postoperative bleeding undergoing Roux-en-Y gastric bypass
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BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE
Publication date: 2024-07-24
Wiadomości Lekarskie 2024;77(6):1127-1133
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ABSTRACT
Aim: To improve the management of morbidly obese patients who undergo gastric bypass surgery to reduce the number of postoperative complications, in
particular, bleeding.
Materials and Methods: From 2011 to 2022, a total of 348 patients with morbid obesity (MO) underwent laparoscopic gastric bypass treatment at the
clinical base of the Department of General Surgery .2 of Bogomolets National Medical University. The retrospective group included 178 patients who received
treatment between 2011 and 2019. 170 patients were enrolled in the prospective group for the period from 2019 to 2022.
Results: Retrospective group had 8 episodes of postoperative bleeding, representing a rate of 4.49%, prospective group – 3 episodes of postoperative bleeding,
representing a rate of 1.76% Four factor characteristics associated with the probability of bleeding were identified: “number of comorbid conditions”, “arterial
hypertension”, “chronic liver diseases” and “chronic obstructive pulmonary disease”
Conclusions: The factors responsible for the occurrence of postoperative bleeding in morbidly obese patients after laparoscopic gastric bypass surgery were
the number of comorbid conditions, the presence of arterial hypertension, the presence of chronic liver diseases, and chronic obstructive pulmonary disease.
A new strategy for the management of morbidly obese patients after laparoscopic gastric bypass was developed. This strategy involves changing cassettes to
create gastroentero- and enteroenteroanastomoses, reducing the period of use of the nasogastric tube, drains, and urinary catheter from 3-4 days to 1 day,
and resuming the drinking regimen 6 hours after extubation.