Unexpected Intraoperative Findings, Situations, and Complications in Bariatric Surgery.
BACKGROUND
Bariatric surgery is considered a safe therapy to treat obesity. Postoperative complications are well known; however, there is a lack of data describing intraoperative complications and/or unexpected findings, and if there is further impact on outcomes.


METHODS
Retrospective study with patients operated between 2013 and 2016 at a single institution. All operative information was collected prospectively and aimed to analyze the incidence and causes of unexpected intraoperative findings, complications, change in surgical plan, extra surgeries, and procedure interruption in patients submitted to bariatric surgery. Secondarily, a morbidity analysis was performed, correlating intraoperative complications with postoperative complications and length of stay.


RESULTS
Four-hundred and five patients were included. Female sex comprised 82% of cases, and a median age of 38 years old was observed; almost 90% were gastric bypass. In 29.3% of cases, there were intraoperative findings, mainly adhesions, abdominal wall hernias, positive methylene blue test, hiatal hernias, and gastrointestinal stromal tumors. Associated surgeries were performed in 8.6% cases, and intraoperative adverse events reported in 7.1%, where organ injury and anastomosis problems were the most frequent. A change in the operative plan was done in 0.9% and surgery interruption in 1.2% of the cases. Early complications were observed in 6.6%. There was no correlation between intraoperative complications and length of stay or early complications.


CONCLUSION
Unexpected intraoperative findings/complications are common in bariatric surgery, but without increasing morbidity or length of stay. Surgery suspension, change in the planned technique, or adding extra (non-bariatric) procedures may occur.
['Joo|Paul|P|', 'Guilbert|Lizbeth|L|', 'Sepúlveda|Elisa M|EM|', 'Ortíz|Cristian J|CJ|', 'Donatini|Gianluca|G|', 'Zerrweck|Carlos|C|0000-0001-7358-2652']
D000328:Adult D050110:Bariatric Surgery D005260:Female D006551:Hernia, Hiatal D006555:Hernia, Ventral D006801:Humans D015994:Incidence D033162:Incidental Findings D007431:Intraoperative Complications D010535:Laparoscopy D008297:Male D008875:Middle Aged D009767:Obesity, Morbid D017063:Outcome Assessment, Health Care D011183:Postoperative Complications D012189:Retrospective Studies D000267:Tissue Adhesions
Obesity Postoperative complications Intraoperative complications Unexpected findings Intraoperative adverse events Bariatric surgery complications Laparoscopic gastric bypass Laparoscopic sleeve gastrectomy Morbid obesity