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Early Postoperative Hemorrhage After Roux-En-Y Gastric Bypass: A Case-Control Study.
Charles T Bakhos, Fuad Alkhoury, Tassos Kyriakides, Randolph Reinhold, Geoffrey Nadzam
Hospital of Saint Raphael, New Haven, CT

Objective: to review the incidence and management of early postoperative hemorrhage after Roux-en-Y gastric bypass (RYGBP), and identify clinical and technical risk factors.
b>Design: retrospective case control study.
Setting: community teaching referral center.
Patients: all patients who underwent open or laparoscopic RYGBP over a 3-year period. Medical records of patients who required postoperative blood transfusions were reviewed for clinical presentation, diagnostic evaluation and management. These patients were compared with a random group of patients who underwent RYGBP during the same time period.
Interventions: none.
Main Outcome Measures: surgical approach (open vs. laparoscopic), type of gastrojejunostomy anastomosis, utilization of ketorolac or pharmacologic DVT prophylaxis, hospital length of stay.
Results: 1025 patients underwent RYGBP during the study period. 33 patients (3.2 %) were diagnosed with postoperative hemorrhage, 17 (51.5 %) of which were gastrointestinal. Hemorrhage occurred earlier (13.8 vs. 25.9 hrs, p=0.039) and was more severe (4.1 vs. 2.3 transfused blood units, p=0.007) in the patients who required surgical re-exploration (n=9). Comparing bleeders and non bleeders, the average age (47.5 vs. 42.2 years, p=0.09), BMI (49.2 vs. 49.7, p=0.83), sex distribution (7 vs. 8 men, p=0.77), surgical approach (16 vs. 18 open RYGBP, p=0.62), gastrojejunostomy anastomotic technique (7 vs. 4 linear stapler, 10 vs. 10 circular stapler, 16 vs. 19 hand sewn, p=0.58), the perioperative utilization of ketorolac (p=0.31) and pharmacologic DVT prophylaxis (p=0.14) were not significantly different. Bleeders had a longer hospital stay (4.94 vs. 4.36 days, p=0.0001).
Conclusions: surgical technique and the perioperative administration of ketorolac or pharmacologic DVT prophylaxis did not seem to influence the incidence of early hemorrhage after RYGBP. This morbid complication frequently requires surgical re-exploration and significantly prolongs the hospital stay.


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