Obesity has become a major health concern in Canada,1
with extreme obesity increasing in prevalence across the country by more than 400% in the last 2 decades.2
Given the rise in obesity rates, the need to increase the capacity to perform bariatric surgery has become a focus of provincial planners. This is reflected in a steady rise in the number of procedures being performed nationwide, with statistical data revealing a 63% increase in the volume of inpatient bariatric procedures performed across Canada in 2008–2009 compared with 2004–2005.3
Whereas there has been evidence to suggest that increased surgical volumes impact positively on survival outcomes,4
data to date have been unable to clearly demonstrate superior outcomes with regards to readmissions, reoperations and mortality in bariatric surgical centres of excellence relative to other surgical facilities.5
There are various surgical options available for the management of morbid obesity. These vary from purely restrictive procedures, such as the laparoscopic adjustable gastric band, to purely malabsorptive procedures, such as the jejunoileal bypass. In an attempt to reduce the complications associated with purely malabsorptive procedures while still improving on the weight loss and comorbidity resolution of the purely restrictive procedures, a number of hybrid restrictive/malabsorptive procedures have been developed. These include the laparoscopic Roux-en-Y gastric bypass (LRYGB), the biliopancreatic diversion and the duodenal switch. Of these, the LRYGB has become the gold standard bariatric procedure to which all others are compared6
and accounts for about 70% of all bariatric surgeries performed worldwide.7
With this in mind, it is therefore prudent that surgeons performing bariatric procedures, as well as the general surgical community as a whole, become aware of the potential complications that can arise from LRYGB and take a rational approach to managing these complications. This review discusses the major perioperative (< 2 wk postoperative) and late complications that can arise in patients who have undergone LRYGB. Emphasis is placed on the principles involved in the management of each complication and the timing of referral to specialist bariatric centres.