Statistics once showed that 1 in 300 died from gastric bypass surgery,
but recent statistics indicate the procedure has become much
safer due to better methods of performing both roux-en-y and
laparoscopic gastric bypass.
People who suffer from morbid obesity can have other serious
medical conditions which are related to or caused by being
overweight.
The higher your BMI is, the more likely it is that
other medical problems will exist. Other medical problems can
increase the risk of complications from gastric bypass surgery
and the recovery period after gastric bypass surgery. Another
risk factor is age, although this increases the need for surgery
there is generally a higher risk. Any medical procedure that
involves humans and reactions to stress, trauma, drugs, and
other causes, unpredictable negative results can and will occur.
This surgery should be considered only after many attempts with
other diet control and exercise have failed. Diet and exercise
will be required before and after this surgery.
Statistical data
associated with this gastric bypass surgical procedure
include: failure to lose weight (about 10%), some complication
of surgery (10% - 15%), serious, life-threatening complication
(about 2% - 3%), and even death (less than 1%). On the other
hand, the risks associated with morbid obesity far outweigh the
risks associated with surgery.
For example, studies prove that
the individual who is 100% over ideal weight has a risk of
mortality that is ten times that of a slender counterpart (that
is, an obese individual's chance of dying is ten times as great
in any given year). There is no question that the potential
benefits of surgery outweigh the risks.
Since
gastric bypass surgical procedures result in some loss of
absorptive function, the long-term consequences of potential
nutrient deficiencies must be recognized and adequate monitoring
must be performed, particularly with regard to vitamin B12,
folate, and iron. Some patients may develop other
gastrointestinal symptoms such as "dumping syndrome" or
gallstones.
Occasionally, patients may have postoperative mood
changes or their pre-surgical depression symptoms may not be
improved by the achieved weight loss. Thus, surveillance should
include monitoring of indices of inadequate nutrition and
modification of any preoperative disorders. The table below
illustrates some of the complications that can occur following
gastric bypass surgery.
Gastric Bypass Surgery Complications: 14-Year Follow-Up
|
Gastric Bypass Surgery Complications |
Number |
Percent |
|
Vitamin B12
deficiency |
239 |
39.9 |
|
Readmit for various
reasons |
229 |
38.2 |
|
Incisional hernia |
143 |
23.9 |
|
Depression |
>142 |
23.7 |
|
Staple line failure |
90 |
15.0 |
|
Gastritis |
79 |
13.2 |
|
Cholecystitis |
68 |
11.4 |
|
Anastomotic problems |
59 |
9.8 |
|
Dehydration
malnutrition |
35 |
5.8 |
|
Dilated pouch |
19 |
3.2 |
Recommendation: Gastric bypass
surgery is an option for carefully selected patients with
clinically severe obesity (BMI 40 or 35 with comorbid
conditions) when less invasive methods of weight loss have
failed and the patient is at high risk for obesity-associated
morbidity or mortality. Evidence Category B.
After gastric bypass surgery, an occasional patient may have a
complication relating to the staple line or the outlet of the
pouch. For example, there might be leakage, perforation, or
bleeding where some staples are dislodged by overstretching of
the pouch. Other possible complications are formation of an
ulcer or stricture or failure of the staple line to heal
properly. These kinds of problems might make additional surgery
necessary. Though all precautions are taken to prevent them,
complications occasionally occur.
For the first month or so, the patient may experience nausea and
vomiting until he or she becomes accustomed to the new small
stomach. Afterwards, patients enjoy a feeling of satisfaction
with small amounts of food.
About one out of twenty-five patients may need to be readmitted
to the hospital because of vomiting. In the first few weeks
after surgery, vomiting may be caused by swelling at the
operative site. Later, there is a possibility that vomiting
might be caused by formation of a stricture, by scarring of the
outlet of the stomach pouch, or by obstruction of the pouch
outlet by a lump of poorly chewed food, tablet, or other foreign
body. In most cases these complications can easily be
corrected, without additional formal surgery.
Because of the limitation of food intake, supplemental vitamins
must be taken. Vitamin supplementation will always be necessary
to minimize the risk of anemia, weakness, muscular
uncoordination, and clinical depression. During the first few
weeks following surgery, a liquid or chewable vitamin is
advised. Afterwards, any good multivitamin preparation
containing adequate amounts of the B-complex vitamins and
minerals is sufficient.
There is some evidence that babies may be born with congenital
abnormalities when there is rapid weight loss during
pregnancy. Therefore, pregnancy should be avoided until weight
has stabilized. Once weight has stabilized, there are no
contraindications to pregnancy.
