Page 68 - World Journal of Laparoscopic Surgery

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)