Surgical intervention for morbid obesity is considered major surgery and, as with all surgeries, carries the risk of general anesthesia. Also, potential complications are more common as weight increases. Risks and complications during surgery may include but are not limited to: Perforation of the stomach or intestine, leak from the esophagus, stomach or bowel with peritonitis or abscess, internal bleeding, wound infection (including opening of the wound), incisional hernia, injury to the spleen with potential removal of the spleen, and bowel obstruction.
Complications which may be encountered after surgery include: pulmonary embolism (blood clots to the lungs from the legs), pneumonia, atelectasis (under inflation of lung tissue), fluid in the chest or other breathing problems may occur. When adjustable bands are placed, there is a significant risk of band erosion, infection involving the band and band slippages. Sequential compression stockings and walking after surgery assist in decreasing the incidence of blood clots.
As with any major surgery, there is the risk of myocardial infarction (heart attack), congestive heart failure, irregular heartbeat, stroke, liver or kidney problems. Although rare, death may occur as a result of one or more of the known potential complications of the surgery (less than 0.2 % for the laparoscopic Roux-en-Y procedure in our practice). This does not include all of the risks when additional procedures are performed.
Other complications include minor wound or skin infections, urinary tract infection, allergic reactions to medications, excessive vomiting/dehydration, development of loose skin, if present, narrowing or stretching of the anastomosis (the outlet of the gastric pouch), peptic ulcer disease, or psychological reactions (including depression) while adjusting to new habits and lifestyle. Other late problems may include failure to lose weight or future weight gain. Lost weight can quickly be regained with continuous overeating, consistent drinking of sweetened liquids, and consumption of snack foods.
Anemia (low red blood cell levels) may occur after gastric bypass. Close attention must be given to iron deficiency, especially in women of childbearing age. Taking a multivitamin with iron usually prevents this problem. Vitamin B12 supplements may also be necessary to prevent anemia. Regularly scheduled blood counts should be performed to monitor for potential deficiencies (at least once a year following gastric bypass surgery).
Malabsorption occurs as a result of gastric bypass surgery. Comprehensive metabolic profiles and folate levels need to be obtained at least once a year. The profiles will evaluate for adequate electrolyte and protein levels. Also, liver function tests will monitor for adequate maintenance of liver function. If abnormalities are identified, further testing with medical and/or surgical intervention may be indicated.
Early Dumping syndrome (fast heartbeat, nausea, vomiting, fainting, sweating and diarrhea) is often a side effect of the operation. Adhering to a sugar free diet will aid in minimizing this syndrome.
Gallbladder disease is commonly associated with morbid obesity. The gallbladder may be removed if preoperative studies confirm symptomatic disease, or if gallbladder disease is noted at surgery. Routine removal of a normal gallbladder during laparoscopic gastric bypass surgery is not recommended.
Ulcers at the stomach anastomosis, intestinal anastomosis, in the stomach pouch or in the large stomach remnant may occur. Marginal anastomotic ulcers may be caused by smoking, overeating, aspirin or non-steroidal anti-inflammatory drugs. Cortisone use in the postoperative period may also lead to a higher incidence of ulcers. If these medications are required postoperatively, additional medication may be required to reduce the risk of developing ulcers. If long term use of these medications is required, an extensive review of post operative treatment options should be performed with the medical doctor prescribing the medications.
The following medications should be avoided following bariatric surgery:
- NSAIDS (ibuprofen, naproxen, ketorolac, etc.)
- Salicylates (aspirin)
- Macrolide Antibiotics (erythromycin, azithromycin and clarithromycin)
- Tetracycline Antibiotics
- Ketolide Antibiotics (telithromycin)
While image is improved, gastric bypass surgery is not merely a cosmetic procedure. The goals are improved quality of daily life, healthier living, longer life, and resolution or improvement of serious associated illness.
An improvement in self esteem and self confidence may be experienced. However, some patients experience social or emotional upheavals. Emotional crisis such as divorce, acute job dissatisfaction, and other problems can occur as a result of all the changes occurring after the operation.