St. Vincent's University Hospital is a tertiary referral centre for bariatric surgery in Ireland. We have compiled a pictorial review of a number of recent interesting cases that have been performed here.

Complications after Roux-en-Y gastric bypass include:

1. Bowel ischemia

2. Small bowel obstruction

3. Internal herniation

Early complications:

Anastomotic leak

GI bleed

Stomal ulceration

Early stricture

Late complications:

Internal hernia

Stomal ulceration

Stomal necrosis

Gastro-gastric fistula

In the case of expected internal herniation:

1. The management is as per bowel obstruction.
2. Insert NG tube
3. Keep nil by mouth
4. IV fluids
5. CT abdomen and pelvis
6. Refer to bariatric service

High suspicion in young patient with pain out of proportion to exam

Complications after gastric banding include:

1. Malpositioned bands

2. Band slippage

Early complications:

Dysphagia

GORD

Band slip

Band/tubing fracture

Oedema/stenosis at band site

Late complications:

Band slip

Band erosion

Port malposition/infection/skin necrosis

Over-inflation

Band/tubing fracture

Oesophageal dysmotility

Failure

1-2% get Achalasia-type dysmotility

2/3 of bands are removed within 10 years because of failure or complications

Early morbidity is low, but gastric bands have the highest long-term risk of any bariatric procedure

Over 50% need reoperation at some stage

In the case of a gastric band slip:

1. Dysphagia to liquids, vomiting, rarely pain should raise suspicion that there is a problem with the band, for e.g. erosion.
2. If symptoms don’t settle after deflation admit patient and refer for urgent surgical work-up and probable band removal on same admission.
3. However if they get good relief from deflation and are tolerating oral fluids with no pain can discharge home with early follow-up with Bariatric service
4. PFA may see slipped band as in previous image
5. Bands contain up to 10ml of fluid, older bands can contain 12ml.
6. Patients carry a card with details of the band and how much fuid it is inflated with.
7. Take a good history – look for precipitates of band slippage. E.g. recent flight. This can cause auto-fill of band.
8. Can also get band unbuckling or leakage of band

Complications after gastric sleeve procedure include:

Early complications:

Staple line leak

GI bleeding (intra/extraluminal)

Vomiting & dehydration

Late complications:

Gastric outlet obstruction

Gallstones

Severe GORD (2%)

17% will get de novo non dysplastic barretts

GORD occurs in 1 in 50 patients.