Infectious Complications in Bariatric Surgery

We have several nowadays several procedures of bariatric surgeries aiming to treat severe obesity and its metabolic and cardiovascular complications. This followed observing substantial weight loss following gastric operations for ulcers nearly four decades ago. But, these patients suffer already comorbidities: type 2 diabetes mellitus, asthma, cardiac diseases and sleep apnea syndrome. Therefore post surgical infectious complications are not only intra-abdominal but extend to the skin, cardiovascular system, pulmonary system, neurological system causing readmissions with the risk of healthcare associated morbidity and mortality they depend on the type of the surgical procedure and on the peri operative preventive measures as skin preparation, nomothermia and tailored targeted antibiotic prophylaxis. The diagnosis is essentially clinical but, in this particular setting of insidious or delayed symptoms, ultrasound and CT scanning are of major help in establishing a rapid diagnosis and prompt treatment. Abdominal rigidity, SIRS manifestations and signs of hypoperfusion are indicative of severe sepsis and often warrant urgent reoperation. Intra abdominal infectious complications are frequently proceduredependant; port infections and band erosions in Laparoscopic Adjustable Gastric Banding, internal hernias and laparoscopic surgery even though this last brought down the rate of all infectious complications. Fistulas, abdominal abscess, hepatic abscess and anastomotic strictures are also encountered and manageable. Anastomotic leaks are the most life threatening occurring in nearly 6% of bariatric surgeries and leading to severe sepsis, ICU admission and high mortality rate. Tailored preparation, judicious antibioprophylaxis, accurate diagnosis, adherence to basic surgical principles, and effective surgical reintervention when necessary with proper medical treatment are the keys in preventing and immediate management of post bariatric surgery infectious complications.