Table 5.

Early post-operative risks of weight-loss surgery: complications, evaluation, and management⁵⁵

Complication	Presentation	Evaluation/Treatment
Bleeding at anastomoses or staple sites	Tachycardia Drop in hematocrit Melena	Slow bleed—reverse anticoagulants Moderate—transfuse, order endoscopy Rapid/unstable—emergent surgery
Infection at wound site (e.g., abscess, pneumonia)	Fever, leukocytosis Erythema, fluctuance	Antibiotics Open/drain fluid collections
Leaks: 2–6% initial RYGB, 35% revisions, 15% mortality	Low-grade fever Unexplained tachycardia	Upper GI, barium swallow or CT Emergent exploratory surgery, drain fluid, broad-spectrum antibiotics
Thromboses: PE/VTE/MI	Tachycardia Shortness of breath Chest pain Hypoxia	If suspected, anticoagulate before imaging (many imaging modalities not feasible) Post-operatively, high-risk patients need 48–72 hr telemetry, EKG, echo (if suspect CHF)
Respiratory compromise or failure	Shortness of breath Tachypnea and hypoxia	Identify/treat OSA pre-operatively If atelectasis, ambulate, incentive spirometry Utilize x-rays, labs as needed to evaluate etiology and determine treatment

Abbreviations: RYGB = Roux-en-Y Gastric Bypass, Upper GI = upper gastrointestinal series, CT = computed tomography, PE = pulmonary embolism, VTE = venous thromboembolism, MI = myocardial infarction, EKG = electrocardiogram, CHF = congestive heart failure, OSA = obstructive sleep apnea