Do you have Questions?
Bariatric procedures are major operations that have immediate life-threatening risks. There is also the potential for long-term side effects, which may impair life quality. These risks and complications will be described for the Roux-en-Y gastric bypass and the LAP-BAND® Adjustable Gastric Banding System. Unknown long-term complications that we are unaware of today may develop in the future.
Surgical Prayers
As surgeons, we are trained to identify and treat diseases that are only cured by surgery. These necessary and sometimes drastic treatments are only possible because of your body's ability to heal itself. (it is not as much about us as it is about you!)
Healing is influenced by a person's overall health which in turn is related to his/her physical status, mental attitudes and spiritual nature.
We acknowledge that we are instruments in the process but not the source of healing. We ask for daily spiritual guidance in our work. As part of this effort, we have developed a partnering relationship with the Sisters of St. Gertrude, a monastery in Cottonwood, Idaho. We feel that their prayers are a powerful and positive way in which we can help improve our patients surgical outcomes. If you are interested in having your name submitted for a prayer of healing during your upcoming surgery, please click here.
RISKS
Death
This is a major operation and carries a death risk of 0.5% or 1 in 200 patients. Most of these deaths occur due to unexpected heart or lung problems. Other causes are blood clots or intestinal “leaking” resulting in infections or peritonitis. Risk of death is slightly higher in the gastric bypass than the LAP-BAND® procedure.
Peritonitis
Leaking from one of the intestinal anastomoses (hookups) can cause infection. If recognized early, this is correctable but will require a second major operation. These leaks occur from staple line failure or from tissue death with failed healing. The risk of this complication is approximately 1 to 3%.
Bleeding Requiring Transfusion/Re-Operation
Severe bleeding occurring at the intestinal anastomoses can be life-threatening. This has an incidence from 0.5 to 2%. A second operation is required to fix this condition.
Intestinal Obstruction
After surgery, adhesions form which may “kink off” the intestine at any level. Adhesions can occur early after the surgery or even years later. A special kind of bowel obstruction called a "closed loop" obstruction occurs when the upper intestine leading from the bypassed stomach becomes blocked. The stomach, liver and pancreas continue to produce juices, which will cause dilation and distension of the stomach, loss of blood supply, and stomach rupture if not detected early. This condition is difficult to detect because the closed loop contains fluid but no air; therefore, this problem is not seen with standard abdominal x-rays.
Surgeons and other physicians who do not work with bariatric patients may not be on the lookout for this dangerous complication. Symptoms include severe upper abdominal pain, nausea, weakness, and vomiting. You may need to clue your doctor in to what is wrong. Always let them know you had a gastric bypass and possibly have a "closed loop" bowel obstruction. An urgent major operation is required to fix this problem. The incidence of this condition is approximately 2 to 5%.
Stenosis of the Gastric Pouch Outlet
Stenosis is due to scarring at the hookup between the stomach pouch and small intestine. It results in frequent vomiting and affects 5 to 10% of patients. Usually stenosis occurs within three to five weeks after surgery and is treated by putting a lighted scope into the esophagus and dilating the pouch outlet with a balloon. Rarely, a major revision of the hookup may be required.
Marginal Ulcer
Ulcers can occur at the stomach hookup point and are almost exclusively seen in smokers or those who overuse aspirin or anti-inflammatory drugs. The incidence of this complication is approximately 1.5%. Because of a higher incidence of ulcers and other complications in smokers, the surgery will not be offered to anyone who is actively smoking.
Blood Clots
Obese people tend to have “thicker” blood and can form blood clots in their legs, particularly after lying still for a long operation. Blood thinners (Heparin) and foot pumps are used to prevent this complication. You may help prevent blood clots by walking and thereby circulating blood soon after surgery. This problem occurs in less than 1% of all patients.?
Pulmonary Embolism
An even more rare complication occurs when a blood clot breaks loose from the leg and migrates to the lungs. This can be fatal. The incidence of this complication is less than 0.5%.
Dumping Syndrome
Dumping syndrome occurs when a high concentration of carbohydrate-rich foods enter into the gastric pouch before digestion is complete. This results in a variety of symptoms including cramping, nausea, palpitations, sweating, and diarrhea. This side effect is considered positive by most patients, reinforcing positive food choices. Dumping syndrome does not occur in the LAP-BAND ® procedure.
Pneumonia
The lungs are compressed during surgery. If not re-expanded soon afterwards, an infection in the form of pneumonia can set in. Coughing and deep breathing after surgery are important to lung health and can reduce the risk of this problem to less than 1%.
Heart Attack
This complication is unusual but can occur in those who have known hardening of the arteries or high blood pressure, as well as other heart disease.
Wound Hernia
This condition has a very high incidence in people who undergo open gastric bypass surgery but is quite rare with laparoscopic surgery. When it occurs, a second surgery is required to fix the defect in the abdominal wall.
Wound Infection
Like wound hernias, this is much more common and significant with open surgery (5 to 7%) and may require several weeks of open wound packing in its treatment. It is uncommon in laparoscopic cases.
Skin Rash/Panniculitis
After weight loss there may be loose, floppy skin folds which trap moisture. This, in turn, causes chronic skin inflammation. This may require plastic surgery for treatment. These expensive procedures are often considered "cosmetic" and may not be covered by insurance payments.
Nausea
Nausea may last several weeks or even months after surgery. It is seen in up to 7% of people and is treated with a variety of medications. For the most part, nausea disappears with time.
Gallstone Formation
Gallstones are known to occur with rapid weight loss. The incidence of gallstone formation is 15 to 30%. This incidence can be reduced if patients take the medicine Actigall in the first six months following surgery. If gallstones are found prior to Roux-en-Y gastric bypass, the gallbladder is removed during the procedure. Adding this procedure to the operation adds risks related to possible bile leak or bile duct stricture.
Nutritional Deficiencies
Protein malnutrition: Although rare with the standard proximal Roux-en-Y gastric bypass, malnutrition is related to inadequate protein intake during rapid weight loss. This can lead to immune system and neurologic system dysfunction. It can be counteracted by use of a variety of protein supplements or intravenous feeding in advanced cases.
Iron deficiency: This is seen in up to 8% of patients and is treated with appropriate food choices in the diet or with iron supplements. Young menstruating females are at greater risk for this complication.
Thiamine/B12: The efficiency of B vitamin absorption is reduced by gastric bypass surgery and requires daily supplementation with a multivitamin rich in B vitamins.
Calcium: Calcium is mostly absorbed in the bypassed duodenum. To prevent development of serious osteoporosis, daily calcium supplementation is recommended.
Hair Loss
Some hair loss will be experienced by most gastric bypass patients during the periods of maximum weight loss. The hair typically has regrowth after a steady nutritional state is regained.
Depression
Where most people experience great improvement in this area, 1 to 2% of people will experience a worsening of this condition.
Pregnancy
Pregnancy is not necessarily a complication of this procedure but can be an unexpected side effect in women of childbearing age. Fertility, hampered by obesity, is often restored when weight loss occurs. Birth control methods are recommended for the first two years after surgery. If you become pregnant after gastric bypass surgery, it is very important to stress adequate nutrition during fetal development. A healthy pregnancy is possible after surgery, but you will have to be monitored very closely.
Unique LAP-BAND® complications
Unique LAP-BAND® complications may include band slippage, erosion, band deflation, obstruction of the stomach, dilation of the esophagus, and port complications (leakage and infection.) Overall complications associated with LAP-BAND ® surgery are 7 to 9% and may require major surgery for correction.