Background

This presentation delves into the challenges of revising bariatric surgery in a 63-year-old male with a history of sleeve gastrectomy in 2013. The patient, dealing with multiple comorbidities such as hypertension, sleep apnea, asthma, anxiety, diabetes, GERD, hyperlipidemia, and atrial fibrillation on coumadin, he went for a Robotic gastric bypass and hiatal hernia repair procedure with 3 incisions. He faced complications postoperatively, including gastrojejunostomy bleeding.

Methods

The patient's postoperative course involved an UGI bleeding with supratherapeutic INR of 15. Urgent endoscopy revealed anastomotic ulcer, pulsatile artery, and exposed sutures, prompting hemostasis with epinephrine injection and 7 clips. Concurrently, atrial fibrillation with rapid ventricular response required Cardizem and cardiology consultation.Collaboration between GI, bariatric surgery, and electrophysiology specialists ensued. Despite initial stabilization, recurrent GI bleeding led to additional endoscopic interventions, hospitalization, and challenges such as transfusions and prophylactic clip placement during a second endoscopy.Outcomes and Follow-up:Following meticulous management, the patient stabilized, was discharged, and scheduled for a Watchman procedure. Challenges during the left atrial appendage closure included transient oozing, requiring a one-night admission. Successful discontinuation of anticoagulation was achieved, and follow-up in the clinic showcased positive evolution with weight loss and improved metabolic health.

Results

This case highlights the intricacies of revising bariatric surgeries complicated by bleeding and comorbidities. The presentation offers insights into multidisciplinary management, emphasizing collaborative efforts among specialties for successful patient outcomes.