Risks of Weight Loss Surgery
Our bodies react to surgery like any other injury. The healing process can increase blood clotting which could lead to an embolism. There is a 1% chance of blood clots occurring in the legs after surgery. This is usually prevented by giving the patient a blood thinner before and after surgery. Using elastic surgical stockings, which compress the legs and keep the blood flowing faster in the veins, is another way of preventing clotting. Keeping the operation as short as possible, and getting the patient up and walking quickly thereafter can also prevent clotting.
Occasionally these blood clots can break off and go to the heart or lungs. This is referred to as a pulmonary embolism and is one of the potential causes of mortality after these operations. This risk is less than 1%.
Infections in the incision area, happening approximately 5% of the time, require opening the wound to drain the infection until the wound heals. This care can be done at home.
Chronic vomiting is another possible complication after surgery. In gastric bypass, the stomach is connected to the bowel and the opening between them is made deliberately small to slow the flow of food out of the small stomach pouch. With healing, scar tissue forms which can sometimes cause further constriction. This may cause the opening between the stomach and the bowel to become so small that food cannot pass through, resulting in repeated vomiting. This complication can be easily corrected in an outpatient procedure during which the opening is stretched by a balloon inserted through a gastroscope down into the stomach. This is successful 90% of the time, but may need to be repeated. If it is not successful, a revisional surgery is required.
Another rare complication of this or any abdominal surgery is a leak from the stitches or staples which are put into the stomach. An emergency operation to seal and drain this leak, followed by antibiotics, will be needed. Sometimes endoscopy is also necessary for further treatment options to allow the leak to heal. Pressure created from vomiting may increase the risk of a leak and is one reason for a pureed diet after surgery and for the need to eat slowly.
Some patients develop gallstones after obesity surgery because rapid weight loss is associated with a 30% chance of forming gallstones. The gallbladder is evaluated with an ultrasound exam prior to surgery. If there are gallstones and a patient is symptomatic, the gallbladder is removed at the time of surgery. If there are no gallstones, Actigal is prescribed after surgery to prevent stones from forming during weight loss. This decreases the risk of gallstone formation to approximately 5%.
Postoperative hernias are not a serious complication but do require surgical treatment to repair. A hernia can result from vomiting or straining after surgery before the incision heals completely. Other causes are infections in the wound or body weight which pulls against the sutures. Hernias occur about 10% to 20% of the time after using a standard open incision. The risk after a laparoscopic procedure is approximately 5%. Currently, we perform all of the bariatric operations through laparoscopic techniques.
Gastric bypass does not allow for normal absorption of iron, B-12 and calcium because that portion of the digestive system which absorbs these vitamins and minerals is bypassed. Deficiencies in these nutrients can lead to many problems. Iron deficiency causes anemia and weakness. Deficiencies in calcium can cause osteoporosis. Lack of daily B-12 can lead to neurological problems. We recommend daily vitamin and mineral supplements for patients who have undergone either type of surgery, but particularly for gastric bypass, sleeve gastrectomy, and duodenal switch patients.
Developing a bowel obstruction after surgery is a possibility after gastric bypass and duodenal switch. Whenever two ends of an incision meet and are sewn together scar tissue forms. This scar tissue can cause adhesions which, in turn, can cause a bowel obstruction. This is a very serious condition and your doctor should carefully explain the symptoms that obstruction may cause.
We recommend life-long annual follow-up with your surgeon to evaluate for any nutritional deficiencies or long-term complications which may arise. Early intervention can help prevent more serious complications.
Benefits of Weight Loss Surgery
Many health consequences associated with obesity are alleviated by weight loss after surgery.
Non insulin dependent diabetes is cured in 80% of diabetic patients after weight loss. Because the surgical procedures restrict the amount of food taken in, and the quantity of sweets consumed is lowered, medication is no longer necessary in 80% of patients.
High blood pressure is cured in approximately half of patients who successfully undergo weight loss surgery. These patients are able to reduce or discontinue their medications and maintain normal blood pressure, eliminating harmful side effects. Your medical doctor will help you decide when medications may be changed.
Weight-induced infertility can be reversed with significant weight loss. However, pregnancy should be delayed for one to two years after surgery until weight becomes stable. Pregnancy is not recommended before that time because the surgery interferes with normal nutrition which is unsafe for the mother and her fetus. However, since weight loss can significantly increase the chances of becoming pregnant, contraception is crucial to avoid an unsafe pregnancy.
Relief from sleep apnea (gaps in breathing during sleep) is a wonderful benefit from surgery for weight loss. Seventy-five percent of patients with sleep apnea find resolution of the problem after surgery.
Hypoventilation, or shortness of breath, is significantly improved or reversed by weight loss. Seventy-five to eight percent of patients who have respiratory problems are demonstrably better after surgery.
Patients who have barely been able to walk because of joint pain find they can now participate in family activities, even sports. Lower back pain and disability from degenerative arthritis and disc disease is usually relieved after surgery. Improvement is evident after the loss of the first 25 to 30 pounds. But, if nerve irritation or structural damage are already present, complete relief of pain cannot be expected. Gastroesophageal reflux or severe heartburn, urinary incontinence, and venous problems of the leg can also improve dramatically.