Early GI Bleeding After Bariatric Surgery

The approach to early postoperative gastrointestinal (GI) hemorrhage, arbitrarily defined as bleeding occurring within 2 weeks after bariatric surgery, differs from that of bleeding in patients with native anatomy. Early GI bleeding is more often a complication associated with Roux-en-Y gastric bypass (RYGB) surgery than other bariatric procedures and typically involves the gastrojejunal anastomosis or gastric staple line. Late GI bleeding, occurring beyond the early postoperative period, is more commonly due to marginal ulceration. Conservative management suffices in many cases, but endoscopy with therapeutic intent should be considered in patients with severe, recalcitrant, or recurrent bleeding. This chapter reviews early postoperative bleeding following RYGB and proposes a management algorithm.