Metabolic and Bariatric Surgery
Core concepts
Understand eligibility criteria, procedure types, and long-term nutritional consequences. Sleeve gastrectomy and Roux-en-Y gastric bypass are the dominant operations; bypass adds malabsorption and dumping risk. Know the workup: multidisciplinary evaluation, psychiatric assessment, and treatment of comorbid disease before surgery.
Complications
- Early: leak (especially at the staple line), bleeding, obstruction, and thromboembolism.
- Late: nutritional deficiencies (iron, B12, folate, calcium, vitamin D), dumping syndrome, marginal ulcers, and weight regain.
- Post-bypass hypoglycemia and internal hernia are classic late problems.
Traps
- Missing a staple-line leak in a tachycardic post-op patient - tachycardia is the earliest sign.
- Forgetting lifelong micronutrient supplementation after bypass.
- Confusing dumping syndrome with hypoglycemia.
- Overlooking alcohol metabolism changes after bypass.
Worked example
A patient two days after gastric bypass with tachycardia and abdominal pain: assume a leak until proven otherwise - imaging and surgical evaluation, not just analgesia. Rule of thumb: unexplained tachycardia after bariatric surgery equals leak until excluded.
Study strategy
Build a comparison table of sleeve versus bypass for anatomy, malabsorption, and deficiency risk. Rehearse the post-op deterioration pathway.