Page 69 - World Journal of Laparoscopic Surgery

Postbariatric Bleeding Linkage to Diabetes and Hypertension
Table 2: Demographic features, diabetes and hypertension, association In De Angelis et al.‘s study on 870 patients who underwent
with RBC transfusion sleeve gastrectomy, the postoperative bleeding rate was 1.9%. In
With transfusion Without transfusion their study, Buttress material was used to prevent bleeding during
(n = 20) (n = 1407) p value the operation. They did not do omentopexy and stapler line routine
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overswing in gastric sleeve surgery. In the present study, the
Demographics bleeding rate was 1.3%. We still believe that omentopexy might
Age (year) a 39 (10.7) 35.8 (9.5) 0.17 reduce intra and postoperative bleeding rates.
Sex In a study by Saber et al., omentopexy reduced surgery-
Male 10 (14.3) 240 (17.7) 0.07 related bleeding. He compared 100 patients with and 100 without
omentopexy done. They found that omentopexy effectively
Female 13 (85.7) 1164 (82.7) reduced postoperative bleeding (0.8 vs 2.3%). We also performed
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Weight (kg) a 124.5 (28.1) 121.8 (20.3) 0.7 omentopexy for all SG patients, and the prevalence of bleeding
Height (cm) a 163.8 (10) 165.3 (28.3) 0.38 after this operation was 1.3% in the current study.
2 a
BMI (kg/m ) 44 (5.5) 44.9 (6.3) 0.001 In Lim et al., which examined a database of 633 patients, the
rate of bleeding after gastric sleeve surgery was 7.4%. Low BMI was
Comorbidities
reported as a risk factor for postoperative bleeding in this study.
DM 7 (35) 222 (15.8) 0.001 They used sealants to strengthen the stapler line, which did not
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HTN 6 (30) 192 (13.6) 0.007 reduce postoperative bleeding. In the current study, BMI did not
BMI, body mass index; DM, diabetes mellitus; HTN, hypertension affect the bleeding rate after bariatric surgery.
a Data reported as mean ± standard deviation In our experience, the best way to reduce bleeding during
b Data reported as the number and percentage in parentheses and after surgery is to prevent it. Accordingly, one way to prevent
intraoperative bleeding is complete intraoperative homeostasis.
By Chi-square test (or Fisher exact test) and independent t-test, Furthermore, we propose omentopexy in SG to prevent intraopera-
the difference between the two groups (with and without the need tive and postoperative bleeding.
for blood transfusion) was statistically significant only in terms of We still believe that intraoperative drain placement will not be
diabetes (p <0.03) and hypertension (p <0.048). necessary to diagnose postoperative bleeding. We also believe that
Patients who needed blood transfusion were 2.9 times more controlling the patient’s vital signs and laboratory tests after surgery
likely to have diabetes OR = 2.9 (95% CI: 1.1–7.3). These patients also would be the best surveillance method for bleeding.
suffered from hypertension 2.7 times more often than other patients In this study, a clear relationship was seen between the history
who did not need blood transfusions OR = 2.7 (95% CI:1.03–7.3). of diabetes and hypertension with postoperative bleeding. Previous
studies have shown an association between intraoperative blood
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dIscussIon pressure changes and postoperative bleeding, but no association
Bariatric surgery is one of the most effective and long-term durable was found between a history of hypertension and postoperative
treatments for patients suffering from morbid obesity. In most bleeding. Therefore, we assume that proper control of the
bariatric operations, the stomach is manipulated. Excessive gastric patient’s blood sugar and blood pressure before, during, and after
perfusion makes these operations prone to bleeding during and surgery may prevent surgery-related bleeding. However, more
after surgery. Moreover, bleeding is still one of the most common postoperative bleeding in diabetic and hypertensive patients may
early complications after bariatric surgeries. Therefore, knowing be due to these diseases’ long-term effects on the patient’s vessels.
more about bleeding risk factors will help take more preventive So, short-term control of blood sugar and blood pressure factors
measures in patients. might not be useful for omitting these risk factors. We recommend
In a study by Zafar et al., performed on 168,093 patients from that in the future, more extensive studies be performed on the exact
742 centers, the rate of postoperative bleeding was 1.2%. The rate role of blood sugar, patient’s blood pressure, and their fluctuations
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of postoperative bleeding in the current study was 1.4. on bleeding in the perioperative period to develop more accurate
In a study by Carabajo et al., on 209 patients who underwent protocols for diabetic and hypertensive patients undergoing
OAGB surgery, two patients (0.9) needed reoperation to control bariatric surgery.
bleeding. The study did not mention patients who needed a According to the current study, a history of diabetes and
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blood transfusion following bleeding. None of the patients who hypertension might be a risk factor for postbariatric surgery
underwent OAGB required reoperation to control bleeding in the hemorrhage. Therefore, it is recommended that bariatric surgeons
present study, but blood transfusions were given to three patients pay more attention to hemostasis during surgery and postoperative
(4.3%) following hemorrhage. care for such patients to prevent bleeding after surgery.
In the study of Spivak et al., bleeding’s relationship after GS However, multicentric studies are recommended to investigate
surgery and a history of diabetes was investigated. Examining the the hemorrhage after bariatric surgery associated with diabetes
databases of 394 patients, they found a link between a history of and hypertension.
diabetes and postoperative bleeding (OR = 2.6). As in the current One of the limitations of this study was the small number of
study, the criterion for acute postoperative bleeding in that study patients who underwent OAGB surgery, so we suggest that these
was the need for postoperative RBC transfusion. Acute bleeding variables be examined more in this operation in the future.
after LSG was reported to be 2.8%, and it was stated that the Patients with a lower drop in hemoglobin levels who did not
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operation technique was not related to it. The rate of bleeding require blood transfusions were not evaluated in this study. Further
after LSG was 1.3% in the current study. We also found a link studies could investigate the risk factors for minor and sub-acute
between diabetes and postoperative bleeding (OR = 2.9). bleeding after bariatric surgery.

World Journal of Laparoscopic Surgery, Volume 15 Issue 2 (May–August 2022) 165