Narcotic withdrawal syndrome following gastric bypass - A difficult diagnosis

Background: it is common for bariatric patients to experience postoperative nausea, depression and remorse for several months following surgery. Diffi culty exists for the surgeon in delineating the physical from the psycholog ical in treating these patients. Preoperative education, evaluation and pre paration, although essential, will not identify nor eliminate all potential problems. Methods: We report the case history of a patient who ultimately underwent r eversal of her gastric bypass. Her symptoms required multiple procedures an d hospital admissions for what appeared to be anatomical problems. All proc edures were done laparoscopically. Results: The patient's main complaints of persistent nausea and abdominal p ain combined with radiographic evidence of sub-optimal anatomic construct l ed to multiple operative procedures. Psychological intervention relative to the persistent nausea and abdominal pain was ineffectual, although the sup portive and consistent nature of the psychotherapy relationship was useful in overall patient stability and emotional well being. Complete reversal of the bypass did not effect improvement. Ultimately, the diagnosis of narcot ic withdrawal prompted the institution of methadone treatment with complete cessation of the symptoms of nausea and pain. Conclusions: The diagnosis of narcotic withdrawal syndrome can be difficult in the postoperative bariatric patient. Psychological evaluation and suppo rt are essential elements of the program throughout the entire course of a patient's treatment experience. Laparoscopic techniques simplified the surg ical care of this patient.