Considering Bariatric Surgery? Please be aware of the risks.
Weight loss surgery should be reserved for patients in whom other methods of treatment have failed and who have clinically severe obesity (once commonly referred to as “morbid obesity”).
Lifelong medical monitoring after surgery is a necessity. Perioperative complications vary with weight and the overall health of the individual. In the published literature, young patients without comorbidities with a BMI 60 kg/m2 who are also diabetic, hypertensive, and in cardiopulmonary failure may have mortality rates that range from 2 to 4 percent. Operative complications, including anastomotic leak, subphrenic abscess, splenic injury, pulmonary embolism, wound infection, and stoma stenosis, occur in less than 10 percent of patients.
Some patients may develop incisional hernias, gallstones, and, less commonly, weight loss failure and dumping syndrome. Patients who do not follow the instructions to maintain an adequate intake of vitamins and minerals may develop deficiencies of vitamin B12 and iron with anemia. Neurologic symptoms may occur in unusual cases. Thus, surveillance should include monitoring indices of inadequate nutrition. Documentation of improvement in preoperative comorbidities is beneficial and advised.
Complications from weight loss surgery are frequent. A study of insurance claims of 2522 who had undergone bariatric surgery showed 21.9% complications during the initial hospital stay and a total of 40% risk of complications in the subsequent six months. This was more common in those over 40 and led to increased health care expenditure. Common problems were gastric dumping syndrome in about 20% (bloatedness and diarrhoea after eating, necessitating small meals or medication), leaks at the surgical site (12%), incisional hernia (7%), infections (6%) and pneumonia (4%). Mortality was 0.2%.*
*Encinosa WE, Bernard DM, Chen CC, Steiner CA (2006). “Healthcare utilization and outcomes after bariatric surgery”.
