Bariatric Surgery
Complications

Alternative names: Gastric Bypass Surgery Complications

Obesity rates are the highest they have ever been, with more and more people turning to bariatric surgery as a solution.  However, this type of surgery is not without its risks.

Bariatric surgery refers to various weight loss procedures that an obese individual can have in order to reduce food intake.  The three most widely-used procedures are gastric bypass, gastric banding and sleeve gastrectomy, each carrying their own risks.

There is no question that obesity is a major cause of potentially life-threatening disease.  The question is whether this risk is greater than the risk of complications arising from bariatric surgery, which depend to a large extent on the procedure that the patient undergoes and other pre- and post-operative factors.

The overall consensus is that the health risks from obesity far outweigh the risks associated with bariatric surgery.  Bariatric surgery is associated with a major reduction in the risk of premature death over a 5-year period.

Incidence; Causes and Development; Contributing Risk Factors

Complications arise in about 10-20% of cases, with serious complications arising in the first 30 days after surgery in 2-4% of cases, depending largely on the experience of the surgeon.

Bariatric surgery is one of the fastest growing hospital procedures performed in the United States, with some 220,000 surgeries being performed in 2008.

Open gastric bypass surgery patients are at higher risk of incisional hernia, organ injury, and wound infection.  Laparoscopic gastric bypass patients have increased risk of bowel obstruction, gastrointestinal tract hemorrhage, and stomal stenosis.

Risk of complications is increased by:

• Inexperienced surgeons
• Size of incision
• Higher BMI (Body Mass Index)
• Pre-existing sleep apnea
• Pre-existing gastroesophageal reflux disease (GERD)
• Pre-existing diabetes
• Pre-existing arthritis
• smoking
• incorrect diet

Treatment and Prevention

Reducing the risk of complications includes choosing the right type of surgery for your situation, choosing a skilled surgeon, educating yourself about the procedure, carefully following medical and nutritional advice, pre-surgery weight loss, eating a healthy bariatric diet prior to surgery, detecting and treating sleep apnea prior to surgery, exercising as soon as possible after surgery, and post-surgery use of blood thinners.

Complications

Complications of bariatric surgery include:

• Abdominal hernia (incision hernia)
• Infection
• Sepsis (more common in severely obese patients and those with diabetes, sleep apnea and arthritis)
• Excess bleeding
• Organ injury
• Intestinal stenosis, the primary symptom almost always being vomiting.  Treated by inserting and inflating a balloon to stretch the affected area.  GERD and increased age increase the risk of strictures.
• Marginal ulceration at the site of surgery.  This can usually be avoided by an appropriate bariatric diet, and avoiding smoking and NSAIDs.
• Blood clots (more common in those with pre-existing deep vein thrombosis, pulmonary embolism, hypertension, or clotting problems)
• Indigestion
• Esophageal dilation (if a lap band surgery patient overeats)
• Hiatal hernia (lap band surgery only)
• Gastroesophageal reflux disease (GERD)
• Bowel obstruction
• Gastrointestinal leakage at stapled or stitched openings
• Constipation
• Diarrhea (less common than constipation)
• Food trapping (after band surgery)
• Food intolerances
• Dehydration
• Low blood sugar
• Nutritional deficiency, especially iron and calcium
• Gallstones
• Kidney stones
• Nausea
• Vomiting
• Band problems (erosion, intolerance, leak, migration, slippage)
• Pouch dilation

Medical News Today reported in 2013 that women who have undergone weight loss surgery are more likely to give birth prematurely and have low birth weight babies.

Despite the many possible risks, overall risk of complications from bariatric surgery is now no greater than that from laparoscopic gall bladder surgery in the US.