73: BARIATRIC SURGERY COMPLICATIONS: MANAGEMENT IN TWO INTESTINAL FAILURE REFFERRAL CENTERS IN ARGENTINA

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Introduction: Obesity is considered a modern pandemic. Several medical strategies have been developed in the last decades. However, the most successful treatment to lose weight is bariatric surgery (BS). This procedure is not free of medical and surgical complications requiring long term medical treatment and/or many re-interventions to be solved, with increased morbidity and mortality. Some patients could develop intestinal failure (IF) consequently. The aim of this study is to report the surgical and medical complications of BS patients referred to two specialized centers in the management of IF in Argentina. Methods: A retrospective analysis of a prospective database of 520 adult IF patients was performed from February 2006 to January 2023. Sex, age, type of BS, medical and surgical complications and PN dependency were assessed. Results: Forty two out of 520 patients (8.1%) were referred with complications of BS. Twenty-nine were females (69.0%) and mean age was 47.12 ± 11.57 years. Surgical procedures were gastric bypass (GYBP) in 34 (81.0%), gastric sleeve in 7 (16.6%) and gastric banding in 1 (2.4%) Thirty-six (85.7%) out of 42 developed IF and 6 (14.3%) intestinal insufficiency. Twenty four out of 36 patients (66.6%) developed chronic IF (CIF) and 12/36 (33.3%) acute IF (AIF) (Table 1) Five out of 24 CIF patients developed medical complications as chronic diarrhea and 19 developed surgical complications (9 hernia, 4 fistula, 2 anastomosis stenosis, 1 ischemia, 1 anastomosis leakage, 1 anastomosis necrosis and 1 abdominal obstruction) Complications appeared in 1 patient in the immediate postoperative period (POP) (within 30 days), in 7 patients in the mediate POP (between 30 days and 6 months) and in 15 patients were on the long term (beyond 6 months). Eight patients underwent autologous gastrointestinal reconstruction surgery and the average number of surgeries required to manage complications was 2.17 (0-3). Fifteen patients achieved PN independence, 8 continued on PN and 1 was lost in follow up. Conclusions: IF can be the result of medical and surgical complications of BS. In this cohort of patients surgical complications were the most frequent cause of CIF. Successful outcomes require a comprehensive and a multidisciplinary treatment in specialized centers in the management of such patients.

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