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Postbariatric Bleeding Linkage to Diabetes and Hypertension
            (Loghman Hakim Hospital in Tehran) is a high-volume bariatric   Table 1: Patients characteristics
            surgery center. Therefore, we aimed to investigate the prevalence   Characteristics        n = 1427
            of postop bleeding in our center. Demographic features (particularly
            diabetes and hypertension) were evaluated as postoperative   Demographics
            hemorrhage’s probable risk factors in this study.     Age (year) a                        35.9 (9.5)
                                                                Sex b
            MAterIAls And Methods                                 Male                                 250 (17.5)
            We reviewed the patients’ database who underwent laparoscopic     Female                  1117 (82.5)
            bariatric surgery (including SG and OAGB) from 2018 to 2020 in   Weight (kg) a           121.8 (20.4)
            Loghman Hakim Hospital, Tehran. The patients’ demographic
            features such as age, sex, weight, BMI, and history of diabetes   Height (cm) a          165.2 (28.1)
            mellitus and hypertension were accessed in all patients. All data   BMI (kg/m )           44.8 (6.2)
                                                                       2 a
            were gathered separately for laparoscopic sleeve gastrectomy (LSG)   Comorbidities
            and laparoscopic OAGB groups. In all SG operations, the stapler line   b
            was reinforced by omentopexy.                         DM                                   229 (16)
               In our center, OAGB surgery has been the option of choice for     HTN b                 198 (13.9)
            patients who are candidates for gastric bypass surgery and had no   Surgery
            contraindications such as severe esophagitis or large hiatal hernia   b
            for this operation. If OAGB was contraindicated, the patient had     SG                   1357 (95.1)
            undergone Roux-en-Y gastric bypass (LRYGB) and was not included     OAGB                   70 (4.9)
            in this study. At the surgeon’s discretion, a Jackson-Pratt drain had   Transfusion
            been selectively placed for OAGB and LSG in patients.            b
               Significant acute postoperative bleeding was evaluated in this     RBC transfusion      20 (1.4)
            study and defined as the need for blood transfusion after surgery   BMI, body mass index; DM, diabetes mellitus; HTN, hypertension; SG, sleeve
            or the need for reoperation to control bleeding.   gastrectomy; OAGB, one anastomosis gastric bypass
                                                               a
               All patients were monitored for blood pressure and vital signs   b Data reported as mean ± standard deviation
            for 12 hours postoperatively, every hour for up to 12 hours, and   Data reported as the number and percentage in parentheses
            then every 3 hours until discharge.                who had undergone bariatric surgery, the study will examine the
               The surgeon was suspected of bleeding if such conditions were   role of demographic characteristics and history of diabetes and
            present: dizziness, tachycardia, pallor, orthostatic hypotension,   hypertension on the possibility of postoperative bleeding.
            abnormal abdominal pain, and significant blood drainage into   This study has been registered and approved in Shahid Beheshti
            the drain (more than 200 mL). Other possibilities such as leakage   University of Medical Sciences’ research department with the
            and pulmonary embolism were also evaluated in such patients   reference code: 24631. Also, the medical ethics committee of this
            according to the clinical signs and symptoms. The selective   university has approved this study with a tracking code:
            evaluations in such patients included charting the drain discharge (if   IR.SBMU.RETECH.REC.1399.623.
            any), oral methylene blue leak test, lab tests (including CBC), upper
            GI series, sonography, and CT scan (if applicable).
               If evaluations were in favor of bleeding after surgery, a CBC (Hb)   results
            check was done serially at 6-hour intervals, and continuous vital   In this study, 1481 morbidly obese patients (257 men and 1224
            signs monitoring was also started for the patient. Also, if there was   women) who underwent bariatric surgery (SG and OAGB) were
            a drain, the amount of blood in the drain had been charted every   studied. These patients’ mean age was 35.9 (9.6%) (13–76-years-old).
            hour. Along with vital signs control and serial hemoglobin check, if   Patients with missing data (n = 54) were excluded from the study.
            there was evidence of bleeding on postoperative ultrasound, serial   Patients data are presented in Table 1.
            ultrasonography had been performed to check the changes in the   As mentioned before, acute significant postoperative bleeding
            extent of intra-abdominal hemorrhage.              is defined as the need for blood transfusion or reoperation to
               The RBC transfusion or the need for reoperation for bleeding   control bleeding in this study.
            control was considered acute significant postoperative bleeding   None of the patients had cardiovascular problems based on
            (based on The Clavien-Dindo Classification of Surgical Complications   the database study. So, the threshold for RBC was seven or fewer
            class II and III). 11                              in the current study.
               The Hb cut-off for RBC transfusion was 7 in non-cardiac and 8   Twenty patients (0.13%) out of these 1481 patients suffered a
            in cardiac patients.                               postoperative hemorrhage.
               All patients’ data, including the need for transfusion or reoperation   In patients who underwent GS surgery, 17 patients (1.3%) and
            for bleeding control, were collected. The rate of postop bleeding in   patients who underwent gastric bypass (OAGB) surgery, three
            all patients who underwent bariatric surgery was calculated. It was   patients (4.3%) required blood transfusion.
            then examined whether demographic characteristics and history   In this study, two patients underwent reoperation to control
            of diabetes and hypertension had been a potential risk factor for   bleeding; both had undergone gastric sleeve surgery and received
            postoperative bleeding or not. For this purpose, all patients who   blood transfusions before reoperation.
            underwent bariatric surgery were divided into two groups (with   The two groups (with and without the need for blood
            and without the need for postoperative blood transfusion). In   transfusion), based on mean demographic features (particularly
            addition to examining the rate of postoperative bleeding in patients   history of diabetes and hypertension), are shown in Table 2.


            164   World Journal of Laparoscopic Surgery, Volume 15 Issue 2 (May–August 2022)
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