Page 67 - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
Diabetes and Hypertension: Is there Any Linkage to the

Hemorrhage after Bariatric Surgery?

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Seyedhadi Mirhashemi , Elham Mirzaian , Latif Gachkar , Fatemeh Ebrahimi , Farbod Emami Yeganeh 5
AbstrAct
Background: Bleeding after bariatric surgery is one of the most common early postoperative complications that can cause morbidity or even
mortality. Therefore, in this study, we investigated the relationship between demographic features and postoperative hemorrhage rate.
Materials and methods: We reviewed the patients’ database who underwent laparoscopic bariatric surgery [sleeve gastrectomy (SG) and one
anastomosis gastric bypass (OAGB)] from 2018 to 2020 in Loghman Hakim Hospital, Tehran, Iran. The patients’ demographic features such as
age, sex, weight, BMI, and history of diabetes mellitus and hypertension were accessed in all patients. Patients who required postoperative blood
transfusion were then identified. Red blood cell transfusion or the need for reoperation to control bleeding was considered as significant acute
bleeding after surgery. The Hb cut-off for red blood cell (RBC) transfusion was 7 gm/dL. The rate of bleeding was determined. By comparing the
two groups (with and without the need for blood transfusion) by Chi-square test and independent t-test, the relationship between demographic
features and postoperative bleeding was investigated.
Results: In total, 1481 morbidly obese patients (257 men and 1224 women) who underwent bariatric surgery SG and OAGB were studied. Twenty
patients (0.13%) suffered a postoperative hemorrhage. In SG, 17 patients (1.3%), and in OAGB, 3 patients (4.3%) required blood transfusion.
The difference in diabetes (p <0.03) and hypertension (p <0.048) in the two groups (with and without the need for blood transfusion) was
statistically significant. Only two patients (10%) who underwent SG were taken to the operating room at the surgeon’s discretion to control
the bleeding (both had a blood transfusion before reoperation). Diabetes (35%) and hypertension (25.7%) were significantly more common
in postoperative bled patients.
Conclusion: Despite all measures to reduce hemorrhage during and after bariatric surgery, bleeding is still one of the most common early
postoperative complications after bariatric surgery. Therefore, recognizing the risk factors for bleeding is still important. In this study, an
association was observed between hypertension and diabetes with postoperative bleeds.
Keywords: Bariatric surgery, Bleeding, Diabetes, Hemorrhage, Hypertension, Laparoscopy complications.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1506

IntroductIon 1,5 Department of General Surgery, Shahid Beheshti University of
Bariatric surgery is one of the main and long-term durable Medical Sciences, Tehran, Iran
treatments for patients with morbid obesity. Due to the increase 2 Department of Pathology, Tehran University of Medical Sciences,
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in morbid obesity, these operations are increasing day by day. Tehran, Iran
Bariatric surgery can cause these people to lose weight by 3 Department of Infectious Diseases and Tropical Medicine, Shahid
restricting or changing the course of food material through Beheshti University of Medical Sciences, Tehran, Iran
the alimentary tract and causing food to be expelled earlier. 4 Department of Neurosurgery, Shahid Beheshti University of Medical
Sleeve gastrectomy and OABG are the most common surgeries. Sciences, Tehran, Iran
Postoperative bleeding is one of the most common causes of Corresponding Author: Farbod Emami Yeganeh, Department of
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morbidity in patients undergoing bariatric surgery. The bleeding General Surgery, Shahid Beheshti University of Medical Sciences,
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rate was reported at 3.1% after bypass and 2% after gastric sleeve, Tehran, Iran, Phone: +98 9121043539, e-mail: farbod555@gmail.com
and the problems caused by anemia can cause many related How to cite this article: Mirhashemi S, Mirzaian E, Gachkar L, et al.
complications in the patients. Red blood cell transfusions can Diabetes and Hypertension: Is there Any Linkage to the Hemorrhage
lead to many complications, such as sepsis, multiple organ failure, after Bariatric Surgery? World J Lap Surg 2022;15(2):163–166.
pulmonary embolism, and even death. 5–7 Some of these problems Source of support: Nil
[including deep vein thrombosis (DVT)] occur due to the release of Conflict of interest: None
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inflammatory mediators following blood transfusion. Bleeding
causes the surgeon to avoid starting anticoagulants for the bleeding
patient. This issue and the need for blood transfusions can lead to bariatric surgery will help reduce this common complication after
DVT of the legs and pulmonary embolism, which is the second most these operations. In cases where it is not possible to change these
common cause of death during the peri-bariatric surgery period risk factors, the surgeon, knowing more high-risk patients, can take
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and the first 30 days after that. Another reason for the importance more preventive measures to prevent postoperative bleeding in
of bleeding after bariatric surgery is that the patients’ surgery time these patients.
with bleeding is longer; they are hospitalized for a more extended Some patient factors reported as a risk factor for perioperative
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period. They are more likely to have reoperation and readmission. bleeding are a history of obstructive sleep apnea, bleeding
Therefore, knowing more about the risk factors for bleeding after disorders, high blood pressure, and diabetes. 2,10 Our center

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