Hemoragia digestivă după roux-en-y gastric bypass

Conau G.; Revencu Sergiu; Conau G.; Revencu Dan; Beschieru Eugeniu

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CONAU, G., REVENCU, Sergiu, CONAU, G., REVENCU, Dan, BESCHIERU, Eugeniu. Hemoragia digestivă după roux-en-y gastric bypass. In: Chirurgia (București, Romania), 2018, nr. S1(113), pp. 13-14. ISSN 1221-9118.

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Chirurgia (București, Romania)

Numărul S1(113) / 2018 / ISSN 1221-9118

Hemoragia digestivă după roux-en-y gastric bypass

Digestive bleeding after roux-en-y gastric bypass surgery

Pag. 13-14

Conau G., Revencu Sergiu, Conau G., Revencu Dan, Beschieru Eugeniu

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“

Disponibil în IBN: 12 decembrie 2021

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Introducere: Roux-en-Y gastric bypass (RYGB) este unul dintre cele mai utilizate procedee la nivel mondial în tratamentul obezitãåii. Acest
procedeu implicã alterarea anatomiei digestive. Hemoragia postoperatorie din stomacul exclus din tranzit, o complicaåie rarã, specificã
acestui procedeu comportã o ratã majorã de morbiditate æi mortalitate. Diagnosticul æi strategia curativã rãmân a fi nerezolvate.
Obiectivul: Stabilirea unui algoritm diagnostico-curativ la pacienåii cu hemoragie digestivã acutã în perioada postoperatorie precoce
dupã RYGB.
Material æi metode: Sunt relatate 12 cazuri (4,9%) clinice din 246 pacienåi supuæi RYGB pe perioada 2009-2018, care au dezvoltat
în perioada postoperatorie precoce hemoragie acutã digestivã. Vârsta a oscilat în limitele 32-58 ani, masa corporalã medie 105±7,4
kg, indicele masei corporale (IMC) a fost în limitele 39,9 ±1,8 kg/m2.
Rezultate: În 4 cazuri pe fundal de hemoragie a survenit dilatarea acutã gastricã, ce a necesitat intervenåie chirurgicalã cu montarea
gastrostomei parietale. În trei cazuri s-a dezvoltat o avalanæã de complicaåii consecutive dilatãrii acute gastrice, care au necesitat
intervenåii repetate.
Concluzii: Hemoragia acutã gastricã poate declanæa o serie de complicaåii consecutive, potenåial letale. Hemoragia din tranæa de
suturã mecanicã pare a fi factorul determinant în iniåierea dilatãrii acute gastrice.

Introduction: Among bariatric procedures, Roux-en-Y gastric bypass (RYGB) is the most performed surgical method worldwide
for the treatment of morbid obesity. This procedure implies alterations of the digestive system. Acute gastric bleeding, a rare
complication specific to this procedure, is a major risk of mortality. The diagnosis and curative strategy remain unsolved.
Purpose: Establishment of an algorithm for diagnosis and treatment for patients with acute gastric bleeding in the early postoperative
period after RYGB.
Materials and methods: We report on 12 cases (4,9%) from 246 patients undergoing RYGB during 2009-2018, that have developed
an acute gastric bleeding in the early postoperative period. Age was situated between 38 and 58 years, the mean body weight was
105±7,4 kg, and the average body mass index (BMI) prior to the surgery was 39,9±1,8 kg/m2.
Results: In 4 cases, acute gastric dilatation occurred after bleeding, requiring surgical intervention in form of percutaneous
gastrostomy. In 3 cases, a set of complications in addition to acute gastric dilatation required repeated interventions.
Conclusions: Acute gastric bleeding may trigger a set of consecutive complications, potentially deadly. Bleeding from the mechanical
suture trance seems to be the main factor in acute gastric dilatation initiation.

Cuvinte-cheie
gastric bypass, hemoragie gastricã, dilatare acutã gastricã,

gastric bypass, gastric bleeding, acute gastric dilatation

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