All surgery has inherent risks and historically bariatric surgery has great risk.   Over the past ten years, by using protocols, treating sleep apnea, preventing clots in the legs, minimizing the size of the liver, and preparing our patients for surgery, we have been able to markedly decrease the complication rate associated with bariatric surgery.   This is a brief description of contraindications, warnings, and adverse events related to bariatric surgery.

Indications:

The gastric band has been approved by the FDA for adult patients with a BMI greater than 30 with one or more serious co-morbidities.  All other Weight Loss Surgery is indicated for use in weight reduction for severely obese patients with a Body Mass Index (BMI) of at least 40 or a BMI of at least 35 with one or more serious co-morbid conditions.

The use of bariatric surgery in adolescents is approved on a case by case basis.

Contraindications:

Weight Loss Surgery is not recommended for patients with serious medical conditions that cannot undergo a general anesthetic.  Patients who are unwilling or unable to comply with behavioral modification should consider alternative methods of weight loss.  Patients who suffer with addiction to tobacco, alcohol or illicit drugs may have increased complications after surgery and should consider alternative methods of weight loss.

Risks:

Risks of Surgery include but are not limited to:

OPERATIVE RISKS

  • Bleeding – Certain medications may increase your risk of bleeding.  It is important to disclose all prescription and over-the-counter medications and supplements that you are taking to your surgeon.  If you have any known bleeding disorders such as hemophilia or severe liver disease, please discuss with your surgeon.   We routinely utilize advanced energy sources, operative techniques, and surgical glue to decrease the risk of bleeding, including high risk patients.
  • Injury to Organs – There is a risk of injury to the liver, spleen, stomach or small intestine due to the proximity of the surgical procedure.  We take our time and dissect with great care and utilize magnification during the procedure to reduce risk.
  •  Ulcer – There are many mechanisms which may results in stomach ulcers.  Long-term use of Non-steroidal Anti-Inflammatory Medications (NSAIDS) such as Advil and Aleve, as well as aspirin, and smoking cigarettes can cause ulcerations.  Bacterial sources may also cause stomach ulcers.  We screen patients prior to surgery for stomach ulcers risks.

 

SHORT TERM POST OPERATIVE RISKS

  • Leak – With any cutting and stapling procedure, there is a risk of a leak in which stomach contents may leak into the abdominal cavity.  PO Diet.  We use additional sutures liberally to decrease the risk of leaks.
  • Infection – Our skin is one of our greatest defenses against infection.   During surgery we breach this protective layer as it is necessary to make small incisions in the abdominal wall so we may introduce surgical instruments.  In an effort to minimize this risk you will be given IV antibiotics at the time of surgery, special soap to wash your abdomen, and oral medications to reduce your risk of microbial infections.
  • Blood clots –  Obesity, abdominal surgery and immobility can all predispose patients to blood clots which can break off and cause death.  We provide special measures, such as blood thinners, compression stockings and early ambulation to minimize our patient’s risks of blood clots.

LONG TERM POST OPERATIVE RISKS

  • Stricture – A stricture is a narrowing of the stomach or intestine.  It is a rare complication that the outlet of a gastric bypass or a portion of a sleeve gastrectomy may become narrowed, but it can occur in a few patients.  It is corrected endoscopically.
  • Band slippage/erosion –  Band erosion is a very rare occurrence in which the gastric band can migrate through the stomach wall.  A band slippage is when a portion of the stomach pushes up through the band, usually as the result of vomiting.  Band slippage (1-3% risk), erosion (less than 1% risk), obstruction of the stomach, dilation of the esophagus, access port problems, infection, or nausea and vomiting may occur. Reoperation may be required to treat such complications.
  • Hair Loss/Hair Thinning may occur with weight loss.  We encourage our patients to keep their protein intake at 70-80g daily, take a daily nutritional supplement (biotin) to aid in the prevention of hair loss and follow up in the office regularly.
  • Malabsorption – Gastric Bypass patients experience the decreased absorption of food nutrients due to re-routing of the small intestine.  Vitamin supplement is essential in this patient group.  Without supplementation patients may suffer long term irreversible nerve injury.
  • Life Style Change – This is one of the most essential segments of our program in which we extensively counsel patients on lifestyle and behavioral modification to insure permanent weight loss.
  • Weight Regain – Bariatric Surgery is intended to act as a tool to aid patients in behavioral modification in losing weight.  Obesity is a disease which is treated but not cured by the weight loss surgical procedure.  Even a small dilation of a pouch or increase in carbohydrate intake may result in an increase in a slow increase in weight.  Follow up nutritional counseling, exercise training, and occasionally revisional surgery may be required to maintain long-term success.

Adverse Events:

Bariatric Surgery is major surgery and, like any surgery, death can occur (mortality rate of 1/1000 to 1/2000 is the current statistic for Center of Excellence Programs). Possible complications include the risks associated with any surgical procedure.

Rapid weight loss may result in complications that can require additional surgery.

Not all contraindications, warnings or adverse events are included in this brief description.