CLINICAL REPORT Understanding the Significance, Reasons and Patterns of Abnormal Vital Signs after Gastric Bypass for Morbid Obesity Omar Bellorin & Abraham Abdemur & Iswanto Sucandy & Samuel Szomstein & Raul J. Rosenthal # Springer Science+Business Media, LLC 2010 Abstract Anastomotic leaks and bleeding are the two most feared major complications in patients undergoing laparo- scopic gastric bypass (LRYGB). This study was designed to evaluate if there is a clinical correlation between abnormal vital signs and postoperative leaks and bleeding. After IRB approval and adherence to HIPAA guidelines, a retrospec- tive review of medical records was performed on 518 patients who underwent LRYGB between October 2002 and October 2006. Vital signs from each patient were monitored hourly. Eight patients out of 518 (1.54%) were discovered to have anastomotic leak. A marked increase in heart rate up to 120 bpm at 20 h after surgery occurred in five of eight patients (62.5%). Of the eight patients who had a leak, seven (87.5%) experienced sustained tachycardia above 120 bpm. On the other hand, 20 patients out of 518 (3.86%) were discovered to have postoperative bleeding. A gradual rather than a dramatic increase in heart rate was recorded in 17 of 20 patients (85%) starting 8 h after surgery. Five patients (25%) had unsustained tachycardia above 120 bpm. Twelve patients in this group (60%) were seen to have cyclical tachycardia that never exceeded 120 bpm at any point during hospitalization. Marginal hypotension was found in seven patients (35%) in this group. Sustained tachycardia with a heart rate exceeding 120 bpm appears to be an indicator of anastomotic leak. Tachycardia less than 120 bpm that has occurred in a cyclical pattern strongly pointed toward postoperative bleeding. Anastomotic leaks and bleeding are the two most feared major complications in patients undergoing LRYGB. This study was designed to evaluate if there is a clinical correlation between abnormal vital signs and postoperative leaks and bleeding. Keywords Laparoscopic Roux-en-Y gastric bypass . Gastrointestinal leak . Gastrointestinal bleeding . Sustained tachycardia . Cyclical tachycardia . Clinical recognition Introduction Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard procedure for morbid obesity in the USA. This weight loss operation accounts for 70% of all bariatric surgeries performed [1]. Although considered a very safe procedure, especially in light of the evolution of laparo- scopic surgery, complications do occur. Anastomotic leak and postoperative bleeding are the most serious complica- tions following this procedure. The incidence of anasto- motic leak ranges from 0% to 4.3% (Table 1)[2]. From a medicolegal standpoint, the most common adverse event initiating litigation against the bariatric surgeon was postoperative leak (53%) and its delay in diagnosis [3]. Gastrointestinal bleeding is a potential complication in both open and LRYGB. In 1993, Wittgrove and Clark performed the first LRYGB [4]. Since then, the laparoscop- ic approach gained popularity in the USA because it is associated with relatively lower perioperative morbidity, shorter hospital stay, and more rapid recovery compared to open RYGB. However, in a review of published literature O. Bellorin : A. Abdemur : I. Sucandy : S. Szomstein : R. J. Rosenthal (*) Section of Minimally Invasive Surgery, Department of General and Vascular Surgery, Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA e-mail: rosentr@ccf.org OBES SURG DOI 10.1007/s11695-010-0221-0