{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T04:51:16Z","timestamp":1775710276410,"version":"3.50.1"},"reference-count":43,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T00:00:00Z","timestamp":1775347200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Gastrointestinal bleeding after metabolic bariatric surgery is a relatively rare adverse event, but it has significant morbidity potential. The clinical course can be rapidly unfavorable, requiring early recognition and prompt intervention. The management of this complication often involves different approaches, surgical or endoscopic, the use of which is influenced by the particularities of the postoperative anatomy and the timing of the bleeding. This study aimed to evaluate the incidence, clinical characteristics, and factors associated with postoperative bleeding following bariatric surgery. Methods: A retrospective observational study was conducted on patients who underwent bariatric surgery between 2012 and 2025 at a single tertiary center. During this period, 1010 bariatric procedures were performed. Of these, 68 patients developed postoperative complications and 24 experienced postoperative bleeding. Postoperative bleeding was defined as a hemoglobin drop &gt; 2 g\/dL and\/or clinically evident bleeding requiring intervention. As bleeding represents a specific subtype of postoperative complication, all statistical analyses were restricted to patients with documented complications. Results: Among the 68 patients with postoperative complications, 24 (35.3%) developed postoperative bleeding. In this exploratory analysis, male sex showed a signal suggestive of association with postoperative bleeding (OR: 9.69, p = 0.005); however, this finding should be interpreted as hypothesis-generating given the study design and the analysis\u2019s being restricted to patients with complications. Given the limited number of bleeding events, effect estimates should be interpreted cautiously. In an exploratory multivariate model, dyslipidemia was associated with increased odds of bleeding (OR: 19.90, p = 0.047), while hepatomegaly and male sex showed positive but non-significant associations. Conclusions: Among patients who developed postoperative complications after bariatric surgery, male sex emerged as a potential signal associated with postoperative bleeding in this exploratory analysis. These findings should be interpreted as hypothesis-generating rather than definitive predictors and require validation in larger cohorts. Dyslipidemia and hepatomegaly emerged as potential associated factors in exploratory analyses, but these findings require confirmation in prospective and multicentric studies.<\/jats:p>","DOI":"10.3390\/jcm15072750","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T02:06:21Z","timestamp":1775441181000},"page":"2750","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating Trends in Bleeding Complications Associated with Metabolic Bariatric Surgery: A 14-Year Single-Center Experience"],"prefix":"10.3390","volume":"15","author":[{"given":"M\u0103d\u0103lina","family":"Maxim","sequence":"first","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, St. Spiridon County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petru Radu","family":"Soroceanu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, St. Spiridon County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5730-1662","authenticated-orcid":false,"given":"Alin Constantin","family":"P\u00eenzariu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, St. Spiridon County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9984-0292","authenticated-orcid":false,"given":"Vlad Ionut","family":"Vl\u0103sceanu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, St. Spiridon County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucian","family":"Ambrosie","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, St. Spiridon County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liviu R\u0103zvan","family":"Platon","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, St. Spiridon County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2820-4534","authenticated-orcid":false,"given":"Alina","family":"Onofriescu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Unit of Diabetes, Nutrition, and Metabolic Diseases, St. Spiridon County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gheorghe","family":"Balan","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Department of Gastroenterology, St. Spiridon County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandru","family":"Filip","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Department of Surgery II, St. Spiridon County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radu Gheorghe","family":"Grigore","sequence":"additional","affiliation":[{"name":"Faculty of Psychology and Education Sciences, \u201cAlexandru Ioan Cuza\u201d University, 700554 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2653-4919","authenticated-orcid":false,"given":"Raoul Vasile","family":"Lupu\u0219oru","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4388-678X","authenticated-orcid":false,"given":"Alexandra Gabriela","family":"Trofin","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6604-874X","authenticated-orcid":false,"given":"Daniel Vasile","family":"Timofte","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, St. Spiridon County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,5]]},"reference":[{"key":"ref_1","unstructured":"Feingold, K.R., Ahmed, S.F., Anawalt, B., Blackman, M.R., Boyce, A., Chrousos, G., Corpas, E., de Herder, W.W., Dhatariya, K., and Dungan, K. (2000). Definitions, Classification, and Epidemiology of Obesity. Endotext, MDText.com, Inc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e00116","DOI":"10.1016\/j.crwh.2019.e00116","article-title":"Perspectives on the Management of Overweight and Obesity","volume":"22","author":"Seib","year":"2019","journal-title":"Case Rep. Women Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1016\/j.soard.2016.03.023","article-title":"Does Sleeve Gastrectomy Improve the Gait Parameters of Obese Patients?","volume":"12","author":"Rebibo","year":"2016","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1007\/s11695-023-06545-y","article-title":"Development of a Bariatric Surgery Core Data Set for an International Registry","volume":"33","author":"Coulman","year":"2023","journal-title":"Obes. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1007\/s11695-024-07118-3","article-title":"IFSO Worldwide Survey 2020\u20132021: Current Trends for Bariatric and Metabolic Procedures","volume":"34","author":"Angrisani","year":"2024","journal-title":"Obes. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/j.amjsurg.2014.08.002","article-title":"Is Laparoscopic Sleeve Gastrectomy a Lower Risk Bariatric Procedure Compared with Laparoscopic Roux-En-Y Gastric Bypass? A Meta-Analysis","volume":"208","author":"Zellmer","year":"2014","journal-title":"Am. J. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"5","DOI":"10.5114\/pg.2021.104733","article-title":"Complications Associated with Laparoscopic Sleeve Gastrectomy\u2014A Review","volume":"16","author":"Diemieszczyk","year":"2021","journal-title":"Gastroenterol. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/j.soard.2011.05.011","article-title":"Incidence and Management of Bleeding Complications after Gastric Bypass Surgery in the Morbidly Obese","volume":"8","author":"Heneghan","year":"2012","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"591","DOI":"10.4253\/wjge.v8.i17.591","article-title":"Endoscopic Management of Post-Bariatric Surgery Complications","volume":"8","author":"Boules","year":"2016","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Maxim, M., Soroceanu, P.R., Vlasceanu, V.I., Galusc\u0103, B., Lupu\u0219oru, R.V., P\u00eenzariu, A.C., Onofriescu, A., Ambrosie, L., Balan, G., and Toader, M. (2025). Complications After Bariatric Surgery: Insights from a 14-Year Single-Institutional Study Without Fistula. J. Clin. Med., 15.","DOI":"10.3390\/jcm15010095"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.cgh.2012.10.043","article-title":"Endoscopic Management of Complications After Gastrointestinal Weight Loss Surgery","volume":"11","author":"Kumar","year":"2013","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Nguyen, N.T., Blackstone, R.P., Morton, J.M., Ponce, J., and Rosenthal, R.J. (2015). Postoperative Bleeding in the Bariatric Surgery Patient. The ASMBS Textbook of Bariatric Surgery, Springer.","DOI":"10.1007\/978-1-4939-1206-3"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1038\/nrgastro.2015.151","article-title":"Major Complications of Bariatric Surgery: Endoscopy as First-Line Treatment","volume":"12","author":"Eisendrath","year":"2015","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s11695-008-9580-1","article-title":"Early Postoperative Hemorrhage After Open and Laparoscopic Roux-En-Y Gastric Bypass","volume":"19","author":"Bakhos","year":"2009","journal-title":"Obes. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.gtc.2004.12.013","article-title":"Endoscopy in the Bariatric Surgical Patient","volume":"34","author":"Huang","year":"2005","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"P\u00eenzariu, A.C., Moscalu, R., Soroceanu, R.P., Maranduca, M.A., Drochioi, I.C., Vlasceanu, V.I., Timofeiov, S., Timofte, D.V., Huzum, B., and Moscalu, M. (2025). The Therapeutic Use and Potential of MSCs: Advances in Regenerative Medicine. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26073084"},{"key":"ref_17","unstructured":"Pappan, N., Awosika, A.O., and Rehman, A. (2025). Dyslipidemia. StatPearls, StatPearls Publishing."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s00423-024-03346-4","article-title":"Preoperative Risk Factors for Early Postoperative Bleeding after Roux-En-Y Gastric Bypass Surgery: A Systematic Review and Meta-Analysis","volume":"409","author":"Nogueiro","year":"2024","journal-title":"Langenbeck Arch. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/j.soard.2022.05.010","article-title":"Risk Factors for Postoperative Bleeding in Bariatric Surgery","volume":"18","author":"Straatman","year":"2022","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/s11695-015-1752-1","article-title":"Complications After Laparoscopic Roux-En-Y Gastric Bypass in 1573 Consecutive Patients: Are There Predictors?","volume":"26","author":"Fournier","year":"2016","journal-title":"Obes. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.soard.2011.12.010","article-title":"Proposal for a Bariatric Mortality Risk Classification System for Patients Undergoing Bariatric Surgery","volume":"9","author":"Nguyen","year":"2013","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.pcd.2019.12.006","article-title":"Prevalence of Comorbidities in Patients with Type\u20132 Diabetes Mellitus","volume":"14","year":"2020","journal-title":"Prim. Care Diabetes"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.jss.2024.04.050","article-title":"Association of Sex Differences on Weight Loss and Complications Following Bariatric Surgery","volume":"299","author":"Hider","year":"2024","journal-title":"J. Surg. Res."},{"key":"ref_24","unstructured":"(2026, January 25). Men Are More Likely to Smoke than Women Almost Everywhere in the World. Our World in Data. Available online: https:\/\/ourworldindata.org\/data-insights\/men-are-more-likely-to-smoke-than-women-almost-everywhere-in-the-world."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"5869","DOI":"10.3390\/curroncol29080463","article-title":"Confronting the Negative Impact of Cigarette Smoking on Cancer Surgery","volume":"29","author":"Choe","year":"2022","journal-title":"Curr. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2899","DOI":"10.37358\/RC.18.10.6649","article-title":"The Effects of Two Nitric Oxide Donors in Acute Inflammation in Rats Experimental Data","volume":"69","author":"Buca","year":"2018","journal-title":"Rev. Chim."},{"key":"ref_27","first-page":"699","article-title":"Nutritional Factors in Transdifferentiation of Scheletal Muscles to Adipocytes","volume":"118","author":"Sindilar","year":"2014","journal-title":"Med.-Surg. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3905","DOI":"10.1007\/s00464-020-07838-4","article-title":"The Effect of Smoking on Bariatric Surgical 30-Day Outcomes: Propensity-Score-Matched Analysis of the MBSAQIP","volume":"35","author":"Janik","year":"2021","journal-title":"Surg. Endosc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4556","DOI":"10.1007\/s00464-013-3122-1","article-title":"A Call to Arms: Obese Men with More Severe Comorbid Disease and Underutilization of Bariatric Operations","volume":"27","author":"Farinholt","year":"2013","journal-title":"Surg. Endosc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3541","DOI":"10.1097\/JS9.0000000000000629","article-title":"Comparing the Safety and Efficacy of Sleeve Gastrectomy versus Roux-En-Y Gastric Bypass in Elderly (>60 Years) with Severe Obesity: An Umbrella Systematic Review and Meta-Analysis","volume":"109","author":"Kermansaravi","year":"2023","journal-title":"Int. J. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5059","DOI":"10.1007\/s11695-020-04994-3","article-title":"Is Laparoscopic Bariatric Surgery Safe and Effective in Patients over 60 Years of Age?\u201d An Updated Systematic Review and Meta-Analysis","volume":"30","author":"Vallois","year":"2020","journal-title":"Obes. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1007\/s11695-023-07040-0","article-title":"Clinical Management of Major Postoperative Bleeding After Bariatric Surgery","volume":"34","author":"Kollmann","year":"2024","journal-title":"Obes. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3232","DOI":"10.1007\/s11695-022-06173-y","article-title":"Early Bleeding After Laparoscopic Roux-En-Y Gastric Bypass: Incidence, Risk Factors, and Management\u2014A 21-Year Experience","volume":"32","author":"Odovic","year":"2022","journal-title":"Obes. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1097\/SLE.0000000000001232","article-title":"Management of Early Postoperative Bleeding After OAGB: A Single-Center Experience","volume":"33","author":"Helmy","year":"2023","journal-title":"Surg. Laparosc. Endosc. Percutaneous Tech."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"7437","DOI":"10.1007\/s00464-023-10201-y","article-title":"Timing and Management of Bleeding after Bariatric Surgery","volume":"37","author":"Naeem","year":"2023","journal-title":"Surg. Endosc."},{"key":"ref_36","first-page":"899","article-title":"Analysis of early severe postoperative complications and risk factors in 4255 patients who underwent bariatric and metabolic surgery in a single cente","volume":"25","author":"Liang","year":"2022","journal-title":"Zhonghua Wei Chang Wai Ke Za Zhi Chin. J. Gastrointest. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.36740\/WLek202406103","article-title":"Improving the Management of Morbidly Obese Patients with Postoperative Bleeding Undergoing Roux-En-Y Gastric Bypass","volume":"77","author":"Ioffe","year":"2024","journal-title":"Wiadomo\u015bci Lek."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1902","DOI":"10.1007\/s11695-022-05973-6","article-title":"Early Postoperative Bleeding After Laparoscopic Roux-En-Y Gastric Bypass: A Single Center Analysis","volume":"32","author":"Pereira","year":"2022","journal-title":"Obes. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11695-022-06059-z","article-title":"Prediction Factors of Early Postoperative Bleeding after Bariatric Surgery","volume":"32","author":"Golzarand","year":"2022","journal-title":"Obes. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1097\/EJA.0000000000002003","article-title":"European Guidelines on Peri-Operative Venous Thromboembolism Prophylaxis: First Update.: Introductory Chapter","volume":"41","author":"Romero","year":"2024","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"4177","DOI":"10.1007\/s00464-019-07191-1","article-title":"Preoperative Anticoagulation in Patients Undergoing Bariatric Surgery Is Associated with Worse Outcomes","volume":"34","author":"Altieri","year":"2020","journal-title":"Surg. Endosc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.soard.2025.09.004","article-title":"Impact of Chronic Anticoagulation on Perioperative Outcomes in Patients Undergoing Minimally Invasive Bariatric Surgery\u2014Propensity Score\u2013Matched Analysis Using the 2020\u20132021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program","volume":"22","author":"Boaz","year":"2026","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"4779","DOI":"10.1007\/s00464-020-07958-x","article-title":"(S029) Managing Therapeutic Anticoagulation in Bariatric Surgery Patients","volume":"35","author":"Shea","year":"2021","journal-title":"Surg. Endosc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2750\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T04:18:26Z","timestamp":1775708306000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2750"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,5]]},"references-count":43,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15072750"],"URL":"https:\/\/doi.org\/10.3390\/jcm15072750","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,5]]}}}