Consultant Corner: Abdominal Pain in the Bariatric Patient

Bariatric surgery is the most effective mean for weight loss and treating its metabolic complications. It is essential to have some understanding of the post-bariatric surgery anatomy in order to understand the potential causes of abdominal pain after these procedures. Abdominal pain in the setting of a gastric band can be due to gastric perforation (early postoperative complication), band prolapse in which the distal stomach herniated up through the band, erosion of the band into the gastric lumen (typically occurs years after placement), and overtightening of the band causing an obstruction. Causes of abdominal pain after sleeve gastrectomy are gastroesophageal reflux disease, hiatal hernia, or stenosis of the gastric lumen. Gastric ulcers are rare after sleeve gastrectomy. Early causes of abdominal pain (aside from incisional pain) after RYGB include small bowel obstruction at the level of the small bowel anastomosis, an incarcerated hernia at a laparoscopic port site or untreated hernia, or evolving abdominal sepsis secondary to an anastomotic leak or bowel perforation. Late causes of abdominal pain after RYGB include small bowel obstruction due to internal hernias or adhesions, ulcers at the gastrojejunal anastomosis (marginal ulcer), small bowel intussusception, gallbladder disease, or other pathology unrelated to the gastric bypass.