Chronic Pain Management After Gastric Bypass Surgery

Evaluation and Diagnosis

The combination of fever, tachycardia, and tachypnea should raise immediate concern for anastomotic leak or staple line complications, requiring prompt surgical evaluation, as recommended by the World Journal of Emergency Surgery 1
Persistent crampy/colicky abdominal pain, especially in the epigastrium, strongly suggests internal hernia which requires surgical intervention, according to the World Journal of Emergency Surgery and Gut 1, 3
Any new onset of abdominal symptoms should trigger suspicion for late complications after bariatric surgery, as clinical presentation can be atypical and insidious, as noted by the World Journal of Emergency Surgery 1

Endoscopic dilatation is the preferred treatment for anastomotic strictures, with triamcinolone or needle knife stricturoplasty reserved for recurrent strictures, as recommended by Gut 4

Postprandial pain after upper GI surgery is commonly due to eating too much at one sitting; patients should be advised to take small bites, divide food intake into 4-6 meals throughout the day, and chew thoroughly, according to Gut and Advances in Nutrition 4, 5
Bowel dysfunction with steatorrhea after upper GI surgery is commonly due to pancreatic exocrine insufficiency, small intestinal bacterial overgrowth, and/or bile acid diarrhea; diagnostic testing and targeted treatment is recommended over empirical treatment, as noted by Gut 4
For dumping syndrome, dietary measures include avoiding refined carbohydrates, increasing intake of protein, fiber, and complex carbohydrates, and separating liquids and solids by at least 30 minutes, as recommended by Advances in Nutrition 5
Symptoms should not be attributed to irritable bowel syndrome until comprehensive investigation and trials of treatment have excluded organic causes, according to Gut 4

Pain control may be achieved with the use of radiation therapy and pain medications for tumor-related pain, as recommended by the Journal of the National Comprehensive Cancer Network 6, 7
Severe uncontrolled pain after gastric stent placement should be treated with immediate endoscopic removal of the stent, according to the Journal of the National Comprehensive Cancer Network 6, 7
For patients experiencing nausea and vomiting with pain, endoscopic or fluoroscopic evaluation should be performed to determine if luminal obstruction is present, as noted by the Journal of the National Comprehensive Cancer Network 7