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Khalaj A, Ghadimi F, Valizadeh M, Barzin M. Successful pregnancy and weight loss management in a woman unknowingly pregnant at the time of bariatric surgery: a case report. BMC Pregnancy Childbirth 2020; 20:94. [PMID: 32041556 PMCID: PMC7011514 DOI: 10.1186/s12884-020-2794-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/06/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Preventing unintended pregnancy is an important issue for women undergoing bariatric surgery, not only to avoid an adverse fetal outcome but to also ensure maximum weight loss for mother. Current guidelines strongly advise to use a reliable method of contraception following surgery and to delay pregnancy for 12-18 months after surgery. CASE PRESENTATION We present the case of a woman who underwent laparoscopic sleeve gastrectomy while she was unknowingly pregnant. She was monitored closely throughout her pregnancy for maternal-fetal wellbeing and delivered a healthy full-term girl. At her last follow-up visit 6 months post-delivery, both mother and infant were in good general condition and the mother achieved 94.4% excess weight loss. CONCLUSIONS In all-female patients of childbearing age planning to undergo bariatric surgery, pregnancy should be avoided by using a reliable method of contraception well before surgery. Pregnancy should also be excluded on the day of surgery.
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Affiliation(s)
- Alireza Khalaj
- Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Fatemeh Ghadimi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Petrucciani N, Ciangura C, Debs T, Ducarme G, Calabrese D, Gugenheim J. Management of surgical complications of previous bariatric surgery in pregnant women. A systematic review from the BARIA-MAT Study Group. Surg Obes Relat Dis 2019; 16:312-331. [PMID: 31837948 DOI: 10.1016/j.soard.2019.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/14/2019] [Accepted: 10/22/2019] [Indexed: 12/29/2022]
Abstract
Considering the large and increasing population of women of childbearing age with history of bariatric surgery, surgical complications of bariatric surgery during pregnancy may become more frequent in the future. The aim of this study was to analyze the clinical presentation, diagnostic procedures, and treatment of surgical complications of bariatric surgery during pregnancies. A systematic literature search was performed in accordance with the PRISMA (preferred reporting items for systematic review and meta-analysis) guidelines to identify all studies published up to and including December 2018 that included women with previous bariatric surgery undergoing emergency surgery during pregnancy. Sixty-eight studies were selected, including 120 women with previous bariatric surgery undergoing emergency surgery during pregnancy. Fifty cases were reported as case reports and 70 in case series. Included patients had previous history of Roux-en-Y gastric bypass (n = 99), laparoscopic adjustable gastric banding (n = 17), Scopinaro procedure (n = 2), vertical banded gastroplasty (n = 1), or one-anastomosis gastric bypass (n = 1). Final diagnosis in 50 case reports was internal hernia in 26 cases, bowel intussusception in 10, intestinal obstruction in 2, laparoscopic adjustable gastric banding slippage in 3, bowel volvulus in 3, gastric or jejunal perforation in 2, and other complications in 4 cases. Maternal and fetal death occurred in 3 (2.5%) and 9 cases (7.5%), respectively. In the case series, the majority of women were operated for internal hernia and laparoscopic adjustable gastric banding slippage. Surgical complications of previous bariatric surgery during pregnancy have potentially severe outcomes. Availability of multidisciplinary expertise, including bariatric/digestive surgeons, and education of healthcare providers and women on clinical signs that require urgent surgical examination are recommended in this setting. Prompt diagnosis is fundamental and based on clinical and laboratory findings and on radiologic examinations if needed, including computed tomography scan or magnetic resonance if available. Rapid surgical exploration is mandatory in case of high clinical and/or radiologic suspicion.
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Affiliation(s)
- Niccolo Petrucciani
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France; Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
| | - Cecile Ciangura
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Nutrition, Sorbonne Université, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Tarek Debs
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon, France
| | - Daniela Calabrese
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Digestive Surgery Department, Sorbonne Paris Cité Diderot, Colombes, France
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
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Dave DM, Clarke KO, Manicone JA, Kopelan AM, Saber AA. Internal hernias in pregnant females with Roux-en-Y gastric bypass: a systematic review. Surg Obes Relat Dis 2019; 15:1633-1640. [PMID: 31378635 DOI: 10.1016/j.soard.2019.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/02/2019] [Accepted: 06/07/2019] [Indexed: 12/27/2022]
Abstract
Improved fertility following a Roux-en-Y gastric bypass (RYGB) can lead to pregnancy and increase the risk of internal herniation. A developing fetus and symptoms of pregnancy can mask the diagnosis and delay intervention, leading to deleterious maternal and fetal consequences. The aim of this systematic review is to summarize the literature regarding internal hernias during pregnancy, their management, and patient outcomes. A comprehensive literature search was undertaken on PubMed and Google Scholar to identify cases of internal hernias presenting during pregnancy after RYGB. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for eligibility and inclusion of articles. Twenty-seven articles, with a total of 59 patients, regarding internal herniation during pregnancy after RYGB were identified. Epigastric pain and nausea and vomiting was the most common presentation. Regardless of orientation of the Roux limb and despite previous closure of mesenteric defects, internal herniation can still occur. A triad of epigastric pain, pregnancy, and a history of RYGB should be a red flag for clinicians to consider internal hernias as a top differential diagnosis. Prompt bariatric consultation and rapid intervention will improve maternal and fetal outcomes.
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Affiliation(s)
- Devangi M Dave
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey; St. George's University School of Medicine, Grenada, West Indies
| | - Kevin O Clarke
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey
| | - John A Manicone
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey
| | - Adam M Kopelan
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey
| | - Alan A Saber
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey.
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Gudbrand C, Andreasen LA, Boilesen AE. Internal Hernia in Pregnant Women After Gastric Bypass: a Retrospective Register-Based Cohort Study. Obes Surg 2016; 25:2257-62. [PMID: 26041066 DOI: 10.1007/s11695-015-1693-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Pregnant women who have previously had laparoscopic Roux-en-Y gastric bypass surgery are increasingly seen in the acute surgical care setting with abdominal pain due to internal hernia. With this study, we want to contribute with our experience and to present our local surgical guidelines concerning this particularly vulnerable patient group. MATERIALS AND METHOD This article is a retrospective study on prospectively collected data. Using data from the Danish National Health Register, we identified 23 women who had bariatric surgery previously and who were admitted to our surgical department and operated on for suspicion of internal hernia. Additional data was collected from patient files and surgical files. RESULTS We identified 23 women who all during pregnancy underwent surgery on suspicion of internal hernia; in 17 patients, the diagnosis was confirmed. We found that laparoscopic approach in our sample was performed as late as the 31st gestational week. All women and foetuses survived this dangerous condition, and none suffered from serious complications, nor did any of the patients have a bowel resection due to small bowel strangulation. CONCLUSION In skilled clinical hands, internal hernia has a good prognosis in pregnant patients. Surgery may be performed subacutely or even electively, depending on the condition of patient and foetus, and straightforward clinical assessment is adequate, and imaging studies, e.g. CT, are not necessary.
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Affiliation(s)
- Charlotte Gudbrand
- Department of Surgery, Hvidovre University Hospital, Kettegård, Allé 30, DK 2650, Hvidovre, Denmark.
| | - Lisbeth Anita Andreasen
- Department of Surgery, Hvidovre University Hospital, Kettegård, Allé 30, DK 2650, Hvidovre, Denmark.
| | - Astrid Elisabeth Boilesen
- Department of Surgery, Hvidovre University Hospital, Kettegård, Allé 30, DK 2650, Hvidovre, Denmark.
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Gruetter F, Kraljević M, Nebiker CA, Delko T. Internal hernia in late pregnancy after laparoscopic Roux-en-Y gastric bypass. BMJ Case Rep 2014; 2014:bcr-2014-206770. [PMID: 25538214 DOI: 10.1136/bcr-2014-206770] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A 27-year-old patient in late pregnancy presented to the department of obstetrics with crampy abdominal pain located in the right flank, 3 years after a laparoscopic Roux-en-Y gastric bypass. Clinical investigation showed tenderness on palpation in the upper abdomen without signs of peritonitis. The cardiotocogram and blood tests were normal. The ultrasound showed a hydronephrosis on the right side, and a pigtail catheter was inserted. The abdominal symptoms did not abate and the abdominal surgeon was consulted 36 hours after admission. Diagnostic laparoscopy was performed promptly because of high suspicion of internal hernia (IH). Laparoscopy showed IH at the mesojejunal intermesenteric defect with a herniated common channel and volvulus of the anastomosis. Conversion to open reduction and complete closure with non-absorbable interrupted sutures was performed. Small bowel resection was avoided. The patient was discharged 10 days after the operation and a healthy boy was born 4 weeks later.
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Affiliation(s)
- Florian Gruetter
- Deparment of Surgery, University Hospital of Basel, Basel, Switzerland
| | - Marko Kraljević
- Deparment of Surgery, University Hospital of Basel, Basel, Switzerland
| | | | - Tarik Delko
- Deparment of Surgery, University Hospital of Basel, Basel, Switzerland
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7
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Altieri MS, Telem DA, Kim P, Gracia G, Pryor AD. Case review and consideration for imaging and work evaluation of the pregnant bariatric patient. Surg Obes Relat Dis 2014; 11:667-71. [PMID: 25620437 DOI: 10.1016/j.soard.2014.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/24/2014] [Accepted: 09/24/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is an increasing trend toward morbid obesity in women of childbearing age and a subsequent increase in number of weight reduction surgeries in these individuals. As a result, special attention needs to be paid to potential postsurgical complications during pregnancy, particularly after Roux-en-Y gastric bypass (RYGB). We are presenting our small case series and our suggestions for management for the pregnant bariatric patient. The aim of this study is to review our institutional experience and present our algorithm to approach pregnant women presenting with abdominal pain and/or emesis after RYGB. METHODS After Institutional Review Board approval, a retrospective chart review was performed at a single center institution between 2010 and 2013. Data regarding clinical presentation, physical exam findings, laboratory values, radiographic studies, intraoperative findings, and clinical outcomes of both mother and fetus were collected and reviewed for pregnant patients with history of RYGB and abdominal distress. RESULTS Five patients were identified. Patient age ranged from 22-34 years (mean 28.4). Gestational age ranged from 9-31 months (mean 19.2). Average body mass index at presentation was 30.3 kg/m(2). Of the 5 patients, 4 presented with abdominal pain and one with intractable emesis. Four patients were taken to the operating room. One was successfully discharged. Two of the patients had an obstruction from adhesions, and the other 2 were found to have internal hernia. There was no mortality for either fetus or mother. One patient required premature delivery at 28 weeks. CONCLUSIONS Pregnant women with history of RYGB who present with abdominal pain should be evaluated urgently for internal hernia or obstruction. A systematic approach is needed to ensure prompt diagnosis.
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Affiliation(s)
- Maria S Altieri
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York.
| | - Dana A Telem
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York
| | - Pamela Kim
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York
| | - Gerald Gracia
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York
| | - Aurora D Pryor
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York
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Wax JR, Pinette MG, Cartin A. Roux-en-Y gastric bypass-associated bowel obstruction complicating pregnancy-an obstetrician's map to the clinical minefield. Am J Obstet Gynecol 2013; 208:265-71. [PMID: 22964065 DOI: 10.1016/j.ajog.2012.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 07/31/2012] [Accepted: 08/07/2012] [Indexed: 12/23/2022]
Abstract
Over 80% of patients undergoing bariatric surgery are women, approximately half of whom are of reproductive age. The most common procedure in the United States is the Roux-en-Y gastric bypass. Small bowel obstruction is one of many recognized postoperative complications. For such a serious condition, this entity presents with remarkable subtlety and is easily misdiagnosed, particularly in pregnant women. The consequences of late recognition can be life-threatening to both mother and fetus. We aim to decrease preventable maternal and perinatal morbidity and mortality by revealing diagnostic and therapeutic missteps related to Roux-en-Y gastric bypass-associated small bowel obstruction.
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Affiliation(s)
- Joseph R Wax
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, ME, USA
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9
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Tuyeras G, Pappalardo E, Msika S. Acute small bowel obstruction following laparoscopic Roux-en-Y gastric bypass during pregnancy: two different presentations. J Surg Case Rep 2012; 2012:1. [PMID: 24960726 PMCID: PMC3649561 DOI: 10.1093/jscr/2012.7.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Bariatric surgery as laparoscopic Roux-en-Y gastric bypass (LRYGB) is increasing throughout the world and women represent the majority (70%) of patients. Most of them are of reproductive age. As a consequence, surgeons will have to treat more and more pregnant patients with a history of LRYGB for surgical abdominal pain. Reported incidence of small bowel obstruction (SBO) varies from 1.5% to 3.5% after LRYGB including internal hernias, intussusception and volvulus. As two cases of maternal postoperative death have been reported in the literature, diagnosis and surgical treatment shouldn’t be delayed especially during pregnancy. To underline the necessity of a rapid diagnosis and surgical treatment, we reported two cases of severe SBO during pregnancy.
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Affiliation(s)
- G Tuyeras
- Hôpital Louis Mourier, Paris, France
| | | | - S Msika
- Hôpital Louis Mourier, Paris, France
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10
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Polavarapu HV, Kurian A, Antanavicius G, Myers VS. Intraoperative fetal monitoring an invaluable tool in pregnant patients with internal hernia after gastric bypass and review of literature. Surg Obes Relat Dis 2012; 8:e40-2. [DOI: 10.1016/j.soard.2011.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 03/13/2011] [Accepted: 03/15/2011] [Indexed: 12/28/2022]
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Bebber FE, Rizzolli J, Casagrande DS, Rodrigues MT, Padoin AV, Mottin CC, Repetto G. Pregnancy after bariatric surgery: 39 pregnancies follow-up in a multidisciplinary team. Obes Surg 2012; 21:1546-51. [PMID: 20820939 DOI: 10.1007/s11695-010-0263-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We investigate the outcomes of pregnancy in women who undergone restrictive-malabsorptive procedure at Centro da Obesidade Mórbida-Hospital São Lucas (COM HSL-PUCRS), Porto Alegre, Brazil. METHODS All pregnancies started after the bariatric surgery and with estimated due date until June 2008 were eligible for the study. Only the first pregnancy of each patient was included in the data analysis. Data was collected from medical records. RESULTS Forty seven pregnancies were identified in 41 women. Eight of them were ineligible. There were 30 complete pregnancies and nine miscarriages (23%). Cesarean delivery was performed in 69% of the complete pregnancies. Mature infants occurred in 93.1%. Twelve pregnancies (30.8%) occurred in the first year after surgery. Vitamin B12 was low in 53.4% patients; folic acid in 16.1%, iron in 6.7%, ferritin in 41.7%, calcium in 16.7%, and albumin in 10.3% of the patients. Nineteen women (79.2%) had no complication during the pregnancy and two (8.3%) presented with internal hernia. The average of newborns weight and length on delivery were 3,037 g and 48.07 cm, respectively. Children from pregnancies started in the first year of post operatory had similar outcomes of children from pregnancies started after 1 year of surgery. CONCLUSIONS Pregnancy after bariatric surgery is safe and has fewer complications than pregnancy in morbidly obese women. However, the recommendation to delay the pregnancy for at least 12-18 months post-operatively should be kept.
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Affiliation(s)
- Flavia Emilia Bebber
- Centro da Obesidade e Síndrome Metabólica do Hospital São Lucas da Pontifica Universidade Católica do Rio Grande do Sul (COM HSL-PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
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Dalfrà MG, Busetto L, Chilelli NC, Lapolla A. Pregnancy and foetal outcome after bariatric surgery: a review of recent studies. J Matern Fetal Neonatal Med 2012; 25:1537-43. [PMID: 22339055 DOI: 10.3109/14767058.2012.663829] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
It is well known that maternal obesity has adverse effects on the health of offspring, causing immediate and long-term morbidities. The various types of procedure coming under the heading of bariatric surgery have proved effective in preventing some maternal and foetal complications in morbidly obese pregnant women. This review aims to assess the role, the risks and the benefits of bariatric surgery for mothers and offspring. According to recent findings, pregnancy and neonatal outcomes in morbidly obese women who have undergone bariatric surgery depend to some extent on the type of surgery used. Maternal complications, nutritional defects and intestinal obstruction are more frequently reported after Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) than after laparoscopic adjustable gastric banding (LAGB) procedures, whereas caesarean section, preterm delivery and neonatal death are more commonly reported after RYGB than after LAGB. The authors of the only long-term follow-up study conducted on this subject reported that the rate of obesity in the children dropped by 52% after bariatric surgery for the mother, and the cases of severe obesity decreased by 45%. Data on pregnancy and bariatric surgery confirm that the procedure is more effective than dietary measures alone in morbidly obese women, and that pregnancy outcome is generally favorable after surgery. Some studies have indicated, nonetheless, that pregnancies after bariatric surgery are at higher risk: the women affected require special medical attention, particularly as concerns gastrointestinal symptoms and vitamin deficiencies, warranting nutritional/dietary counselling by a multidisciplinary team before, during and after pregnancy.
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Affiliation(s)
- Maria Grazia Dalfrà
- Department of Medical and Surgical Sciences, Padova University, Padova, Italy
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Abstract
This article reviews the use of radiological imaging in the post-gastric bypass patient. A thorough understanding of the reconstructed anatomy is critical to interpret imaging abnormalities, when present. Radiological imaging can help guide the surgeon's management in this specific patient population.
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Affiliation(s)
- Shanu N Kothari
- Department of General and Vascular Surgery, Gundersen Lutheran Health System, 1900 South Avenue C05-001, La Crosse, WI 54601, USA.
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14
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Rosenkrantz A, Kurian M, Kim D. MRI appearance of internal hernia following Roux-en-Y gastric bypass surgery in the pregnant patient. Clin Radiol 2010; 65:246-9. [DOI: 10.1016/j.crad.2009.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 11/25/2009] [Accepted: 12/04/2009] [Indexed: 10/19/2022]
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Laparoscopic repair of internal hernia during pregnancy after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2010; 6:88-92. [DOI: 10.1016/j.soard.2009.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 06/04/2009] [Accepted: 06/04/2009] [Indexed: 11/23/2022]
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Efthimiou E, Stein L, Court O, Christou N. Internal hernia after gastric bypass surgery during middle trimester pregnancy resulting in fetal loss: risk of internal hernia never ends. Surg Obes Relat Dis 2009; 5:378-80. [DOI: 10.1016/j.soard.2008.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
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Guelinckx I, Devlieger R, Vansant G. Reproductive outcome after bariatric surgery: a critical review. Hum Reprod Update 2009; 15:189-201. [PMID: 19136457 DOI: 10.1093/humupd/dmn057] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND After many cycles of weight loss and weight gain, more and more morbidly obese patients undergo bariatric surgery, like gastric banding or gastric bypass, as the ultimate treatment for their obesity-problem. Since women of reproductive age are candidates for bariatric surgery, concerns arise regarding the potential impact on future pregnancy. METHODS English-language articles were identified in a PUBMED search from 1982 to January 2008 using the keywords for pregnancy and bariatric surgery or gastric bypass or gastric banding. RESULTS The few reported case-control and cohort studies clearly show improved fertility and a reduced risk in obstetrical complications, including gestational diabetes, macrosomia and hypertensive disorders of pregnancy, in women after operatively induced weight loss when compared with morbidly obesity women. The incidence of intrauterine growth restriction (IUGR) appears to be increased, however. No conclusions can be drawn concerning the risk for preterm labour and miscarriage, although these risks are probably increased compared with controls matched for body mass index. Operative complications are not uncommon with bariatric surgery and several cases have pointed to the increased risk for intestinal hernias and nutritional deficiencies in subsequent pregnancy. Deficiencies in iron, vitamin A, vitamin B(12), vitamin K, folate and calcium can result in both maternal complications, such as severe anaemia, and fetal complications, such as congenital abnormalities, IUGR and failure to thrive. CONCLUSIONS Close supervision before, during and after pregnancy following bariatric surgery and nutrient supplementation adapted to the patient's individual requirements can help to prevent nutrition-related complications and improve maternal and fetal health, in this high-risk obstetric population.
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Affiliation(s)
- Isabelle Guelinckx
- Department of Nutrition-Preventive Medicine, Leuven Food Science and Nutrition Research Centre, University Hospital Gasthuisberg, Catholic University Leuven, Belgium.
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Small Bowel Obstruction and Internal Hernias during Pregnancy after Gastric Bypass Surgery. Obes Surg 2008; 19:944-50. [PMID: 18830790 DOI: 10.1007/s11695-008-9681-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
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Wax JR, Pinette MG, Cartin A, Blackstone J. Female reproductive issues following bariatric surgery. Obstet Gynecol Surv 2007; 62:595-604. [PMID: 17705885 DOI: 10.1097/01.ogx.0000279291.86611.46] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED One in 3 adult American women is obese. Almost half of the approximately 100,000 bariatric surgeries performed in 2004 were on reproductive-aged women. Anatomic and physiologic changes resulting from such surgery may have significant clinical implications for preconception, pregnancy, and postpartum care. This review summarizes these issues and the available related literature, and offers guidelines for care of these patients. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader should be able to recall that bariatric surgery has many anatomic and physiologic changes that potentially will affect future pregnancies, and state that attention to these physiologic changes and attention to potential nutritional deficiencies significantly improves the chances of a good pregnancy outcome.
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Landsberger EJ, Gurewitsch ED. Reproductive implications of bariatric surgery: pre- and postoperative considerations for extremely obese women of childbearing age. Curr Diab Rep 2007; 7:281-8. [PMID: 17686404 DOI: 10.1007/s11892-007-0045-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Extreme obesity remains a frustrating and formidable disease, with most sufferers requiring surgical intervention in order to achieve long-term, sustained weight loss. Most bariatric procedures today are performed on women, many of whom are of reproductive age; yet minimal evidence exists to guide clinicians in the care of such women before, during, and after pregnancy. This review outlines the fundamental nutritional and surgical alterations of the most commonly performed bariatric procedures with the aim to elucidate a physiologically sound approach to counseling and management of extremely obese women of childbearing age who are either contemplating or have already undergone bariatric surgery. Preconception, pregnancy, and lactation guidelines are offered based on available evidence. Outstanding questions are highlighted for further investigation.
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Affiliation(s)
- Ellen J Landsberger
- Department of OB/GYN and Women's Health, Division of Maternal-Fetal Medicine, Weiler Hospital of Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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21
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Patel JA, Colella JJ, Esaka E, Patel NA, Thomas RL. Improvement in infertility and pregnancy outcomes after weight loss surgery. Med Clin North Am 2007; 91:515-28, xiii. [PMID: 17509393 DOI: 10.1016/j.mcna.2007.01.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The majority of bariatric surgical procedures are performed in young women. There is a concern about safety and outcomes of pregnancies after weight loss surgery. Pregnancy after weight loss surgery is not only safe, but is associated with more favorable outcomes in comparison to obese populations who do not undergo weight loss surgery. An interval of 2 years is recommended from surgery to pregnancy. This delay helps avoid most of the potential nutritional complications. Optimal patient care is achieved in an experienced, multidisciplinary center. Early involvement of the bariatric surgeon in evaluating abdominal pain is critical because the underlying pathology may relate to the previous weight loss surgery. Although infertility is improved after weight loss surgery, reliable modes of contraception may be limited in this population.
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Affiliation(s)
- Jitesh A Patel
- Department of Surgery, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA
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