One of the most dreaded and quite possibly devastating complications of this procedure, with a mortality rate of nearly 50 %, is an anastomotic leak. A multivariate study of 3000 patients who underwent LRYGB concluded that an anastomotic leak was one of the strongest independent risk factors for postoperative death. The incidence of leak is relatively low at 0.4–5.2 % [1].

The most common site for a leak is at the gastrojejunal anastomosis. Generally, clinical signs such as tachycardia, fevers, nausea/vomiting, and abdominal pain are indicators of a leak. A recent study concluded that sustained tachycardia with a heart rate in excess of 120 beats per minute was a good indicator [2]. Early operative management is typically the treatment for leaks following LRYGB. The goal of the operation is to find and repair the leak, remove gastric contents from the abdomen, and place drains [1]. Patients are then treated with IV antibiotics and fluids. They are also maintained NPO until their symptoms improve.

As mentioned earlier, dumping syndrome occurs when a large bolus of food enters the stomach and small intestines too rapidly. It can be divided into both early and late stages. The early stage occurs within 15–30 min after eating. The late stage occurs hours after a meal. In the early stage, the large fluid bolus causes hyperosmolar shifts in the small intestines. This is in turn draws large amounts of fluids into the gut lumen and causes overdistention. This causes symptoms such as nausea, vomiting, bloating, diarrhea, and fatigue. The symptoms of the late stage of dumping occur due to hypoglycemia. In reaction to the large hyperosmotic load and fluid shifts, the pancreas releases a large amount of insulin into the bloodstream. These symptoms include diaphoresis, weakness, and fatigue. The simple solution to this is to eat smaller portions [3].

Deep vein thrombosis (DVT) with resultant pulmonary embolism is the most common cause of death after bariatric surgery. Although the incidence of such an event is only 2 %, the mortality associated with it is around 20–30 % [4]. In order to avoid such a complication, patients are given chemoprophylaxis in the form of subcutaneous heparin or Lovenox. Perhaps the most important intervention is to encourage early ambulation including postoperative day 0. Sequential compression devices are applied to allow constant circulation of blood in the lower extremities.