The Bariatric Surgery Program

Risks and Complications of Bariatric Surgery

Indication
Weight loss surgery is typically reserved for those individuals 100 pounds or more overweight (Body Mass Index [BMI] of 40 or higher) who have not responded to other less invasive therapies such as diet, exercise, medications, etc.

In certain circumstances, less morbidly obese patients (with BMIs between 35 and 40) may be considered for surgery (patients with high-risk co-morbid conditions and obesity-induced physical problems that are interfering with quality of life).

Important Considerations
Surgery should not be considered until you and your doctor have evaluated all other options. The proper approach to weight-loss surgery requires discussion and careful consideration of the following with your doctor:

• These procedures are in no way to be considered as cosmetic surgery.
• The surgery does not involve the removal of adipose tissue (fat) by suction or excision.
• A decision to elect surgical treatment requires an assessment of the risk and benefit to the patient and the meticulous performance of the appropriate surgical procedure.
• These weight loss surgical procedures (approved in the United States) are not reversible.
• The success of weight loss surgery is dependent upon long-term lifestyle changes in diet and exercise.
• Problems may arise after surgery that may require reoperations.

Success of surgical treatment must begin with realistic goals and progress through the best possible use of well-designed and tested operations.

Complications and Risks

As with any surgery, there are operative and long-term complications and risks associated with weight loss surgical procedures. Such risks will be reviewed with you during a consultation with the bariatric multidisciplinary team. Possible risks include, but are not limited to:

• Bleeding
• Complications due to anesthesia and medications
• Deep vein thrombosis (pulmonary embolism)
• Blockage
• Dehiscence
• Infections
• Leaks from staple line breakdown
• Marginal ulcers
• Pneumonia
• Infection
• Pulmonary problems
• Gallstones
• Spleen injury
• Vomiting
• Stenosis
• Bowel obstruction
• Death

Bleeding
Bleeding, although rare, comes from the raw staple lines.  Blood is passed out of the rectum with the stool.  Some patients may pass a little blood in their first few stools.  Patients rarely need a blood transfusion from post-op bleeding.  Although extremely rare, blood may also come from bleeding into the abdomen outside of the intestine.

Patients must discontinue use of anti-inflammatory medications, herbal supplements, vitamins and aspirin prior to surgery as this may increase the risk of bleeding.

Pulmonary Embolism
Pulmonary embolus usually comes from a deep venous thrombosis or blood clot that forms in the veins of the pelvis.  A part of the blood clot breaks away and goes up to the lungs, blocking the blood returning to the heart.  It can be fatal but occurs in less than 1% of patients who have weight loss surgery.

We take every medical precaution to help prevent blood clots.  After surgery, while you are in the hospital, you are given a blood thinner that guards against clotting.  You are fitted with SCD’s (sequential compression device) that pneumatically 'squeeze' the blood vessels in your legs.  The stockings actually 'bruise' your blood and help to prevent clotting.  We get you out of bed four or five hours after surgery to walk.  You will be required to walk every two hours for your entire stay in the hospital with the exception of about six hours for sleep.  You need to walk as much as possible while in the hospital and upon your return home.

Blockage at a Site Where Tissue Is Stapled or Sewn Together
Blockage only occurs in about 2.5% of patients.  Blockage is primarily caused by tissue swollen after surgery.  Typically, internal swelling will go down and re-operation will not be necessary.

Leakage from a Staple Line
Leakage occurs in 1 to 4% of the patients.  Most leaks occur within the first week of post surgery.  The staple line is tested three times: twice in the operating room and once the morning after surgery.  A small Jackson-Pratt drain is placed in the area to hold any fluid that leaks out. 

Pneumonia
Pneumonia occurs in less than 1% of patients.  It involves an infection in the lungs resulting from collapsed air sacks.  Patients must focus on walking, breathing, and coughing exercises after surgery to prevent this complication.

Infection
Because there are very small incisions made from the laparoscopic procedure, this is not common.

Gallstones
Gallstones are the most common cause of gallbladder disease.  We test for gallstones prior to surgery, as you may need to have your gallbladder removed before the time of surgery.  Gallstones occur when bile forms solid particles (stones) in the gallbladder.  The stones form when the amount of cholesterol or bilirubin in the bile is high.  Poor muscle tone may keep the gallbladder from emptying completely.  The presence of residual bile may promote the formation of gallstones.  Risk factors for the formation of cholesterol gallstones include:

• Female sex
• Being overweight
• Losing a lot of weight quickly on a "crash" or starvation diet
• Taking certain medications such as birth control pills or cholesterol-lowering drugs

Vomiting
Vomiting is the most frequent complication experienced by patients.  It is usually more like 'spitting up' than vomiting.  Frequent vomiting is usually caused by eating too fast or overeating.  If you begin having a persistent problem with this after surgery, you need to contact our office.

Insufficient weight loss
There is less than a 10% chance that you will not achieve your desired weight loss

Death
For patients who undergo weight loss surgery in the United States, the approximate risk of death is 0.5%.  This means that 1 in 200 patients may die this year having a weight loss procedure.  

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