СOMPLICATIONS AFTER GASTRIC BYPASS SURGERY IN OBESITY
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Abstract
Purpose – demonstration of clinical cases of treatment of patients with bleeding peptic ulcers of the gastrointestinal anastomosis after double-anastomosis and single-anastomosis gastroshunting, combined in one case with a complicated form of gallstone disease.
Materials and methods. Clinical data and results of examination and treatment of three patients with gastric bleeding at different times after single- and double-anastomosis gastroshunting are presented.
Results. Three cases of gastric bleeding from peptic ulcers of the gastrointestinal anastomosis after one- and two-anastomosis gastroplasty in obesity are presented. In one case, 2 months after surgery with an arereflux anastomosis, an emergency Roux-en-Y gastric resection was performed due to ongoing bleeding from a peptic ulcer of the anastomosis. In two cases, endoscopic hemostasis and conservative therapy were effective, and the aggressiveness of the gastric juice from the operated stomach was studied. The criterion of aggressiveness was the level of acid proteolysis. In the first patient, the digesting activity of the stump juice was high, which explained the cause of the peptic ulcer of the gastroenterostomy. In the second patient with a reflux anastomosis, the acid proteolysis was low, and the appearance of the ulcer 3 years after gastroshunting was associated with a decrease in the inhibitory effect of bile on acid proteolysis in the gastroenterostomy area due to obstructive cholestasis and mechanical jaundice.
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