IBC Oxford University Oral Abstract 36 - Predictive factors of postoperative haemorrhagic complications after laparoscopic Roux-En-Y gastric bypass: analysis of a high-volume centre

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Abstract Introduction Laparoscopic Roux-En-Y gastric bypass (LRYGB) is one of the most performed procedures for morbid obesity. Morbidity and mortality associated with bariatric surgery are considered low. Nevertheless, post-operative haemorrhage is the most frequent early complication after LRYGB. Methods We conducted a retrospective cohort study regarding all patients submitted to LRYBG between 2019 and 2023 at our centre. Postoperative haemorrhage was defined as clinically significant evidence of bleeding in the early postoperative period (first 30 days). Demographic, preoperative and intraoperative characteristics of our population were evaluated. We aimed to assess associations and predictive factors of postoperative haemorrhage in our population. Results Our population comprised a total of 2117 patients submitted to LRYGB. Most were female (86.3%) and mean age was 47 years old. Mean pre-surgical body mass index (BMI) was 41.8 kg/m2. Regarding previous comorbidities, 23.1% had diabetes, 44.2% hypertension and 33.1% dyslipidaemia. Of the 2117 cases, 307 (14.5%) were revisional surgeries. Concerning postoperative complications, 47 (2.2%) patients had early postoperative haemorrhagic events. Of those, 2 (4.2%) had extraluminal haemorrhage and underwent surgical reintervention. The remaining 45 (95.8%) had intraluminal bleeding and were managed conservatively. Previous cholecystectomy was significantly more prevalent amongst these patients (21.3% versus 11.0%, P = 0.028). However, no statistically significant differences were found according to age, gender, pre-surgical BMI, left liver lobe diameter as well as for revisional surgery. Patients with bleeding complications had a longer hospital stay (2.8 days versus 3.7 days) as well as higher number of reinterventions and readmissions (8.5% versus 3.1%, P = 0.039 and 10.6% versus 3.4%, P = 0.008, respectively). Early postoperative complications include leakage, bleeding and obstruction. Even though these are considered common, postoperative morbidity remains low, particularly in high-volume centres. Adequate and on time management is of utmost important. Conclusions Intraluminal bleeding is usually managed conservatively, especially if hemodynamical stability is present, however extra-luminal haemorrhages are more likely to impose surgical treatment, just as shown in our series. Importantly, one must focus on the early detection, diagnosis and treatment for the purpose of patient and treatment outcome improvement. The identification of risk factors for such complications is of utmost importance, to allow for the implementation of perioperative strategies in high-risk patients.

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