Rethinking post-bariatric care: anorectal morbidity following sleeve gastrectomy and roux-en-Y gastric bypass

BACKGROUND: Bariatric surgery is a prevalent and effective treatment for morbid obesity, yet its potential long-term effects on anorectal health remain an under-investigated aspect of post-operative care. This study aimed to meticulously evaluate the incidence and the degree of severity of two common anorectal conditions, anal fissures and hemorrhoids, in a substantial cohort of patients following either sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB), two frequently performed bariatric procedures. Understanding these potential post-surgical morbidities is crucial for a comprehensive approach to patient management. METHODS: A retrospective cohort study at a large tertiary referral center (2015-2023) included 280 patients (200 SG, 80 RYGB). Detailed pre- and post-operative data on anorectal conditions, bowel habits, and surgical outcomes were extracted from electronic records and statistically analyzed. RESULTS: The overall incidence of new-onset anorectal disorders (defined as the development of at least one of the conditions) was significantly higher in the RYGB group (47.5%) compared to the SG group (32.5%) ( P <0.001). Specifically, the incidence of new-onset hemorrhoids (36.5% vs. 23.5%, P =0.02) and anal fissures (29.0% vs. 16.0%, P =0.01) occurred more frequently in the RYGB group. The mean severity scores were also higher (Goligher score: 2.6±0.8 vs. 2.1±0.7, P = 0.01; fissure severity: 2.9±1.0 vs. 2.3±0.9, P = 0.02). Post-operative constipation and diarrhea were associated with higher risk, and RYGB was an independent predictor. Multivariate analysis, adjusting for age, sex, and baseline BMI, confirmed RYGB (OR 1.7, 95% CI 1.1-2.5, P =0.01) and post-operative constipation (OR 2.0, 95% CI 1.3-3.0, P =0.001) as independent predictors of new-onset anorectal disorders. CONCLUSIONS: Our findings highlight that not all bariatric procedures carry the same risk for anorectal complications, and RYGB specifically warrants closer attention. These findings underscore the clinical importance of incorporating proactive assessment and management of anorectal health, including bowel habit regulation and symptom monitoring, into the routine post-operative care of bariatric surgery patients to optimize their overall well-being.