Summary of recommendations
| Postoperative period | Signs/symptoms | Differentials | Investigations/actions |
|---|---|---|---|
| Early | Sustained tachycardia (> 120 beats/min) | Anastomotic or staple line leak Substantial postoperative hemorrhage | Return to OR for diagnostic laparoscopy/laparotomy |
| Bilious vomiting | R/O Roux-en-O configuration | HIDA scan with possible return to OR | |
| Abdominal pain and vomiting | R/O internal hernia | UGI series with possible return to OR | |
| Late | Colicky abdominal pain after meals Excessive weight loss | R/O internal hernia | CT scan with possible return to OR for diagnostic laparoscopy |
| Profound weight loss and vomiting | R/O anastomotic stricture | UGI series UGI endoscopy Nutritional testing Interventions based on results | |
| Weight gain | R/O gastrogastric fistula Noncompliance | UGI series UGI endoscopy Consider referral to specialized multidisciplinary bariatric team |
CT = computed tomography; HIDA = hepatobiliary iminodiacetic acid; OR = operating room; R/O = reoperation; UGI = upper gastrointestinal.