Risks and Benefits of Weight Loss Surgery

The risk of having weight loss surgery is the same as the risk for having any abdominal surgery. It’s the fact that you’re having an operation period…not the particular operation that you’re having.

Some of the risks are:

Infection

Abscess-An abscess is where infected puss or fluid collect in the body. After surgery, if a pocket of fluid develops in your body and bacteria are present, the bacteria could infect the fluid and form an abscess. Draining away the infected fluid or puss and then treating the patient with antibiotics controls abscesses. Many surgeons place drains in their patients’ abdomens to prevent fluid from collecting in the first place.

Wound Infection-A wound infection is an abscess and is treated the same way as other abscesses. It is often difficult to treat abscesses in the morbidly obese because the thick layer of fat under the patient’s skin prevents the surgeon from treating the abscess in the usual manner. However, if you have a highly skilled surgeon, he or she knows the correct and most efficient way to treat abscesses in the morbidly obese.

Urinary Tract Infection-After surgery, patients often have trouble straining down to urinate. Many surgeons opt to use a catheter to drain the bladder. In rare cases, this can lead to infection of the bladder. Usually taking antibiotics can easily treat a bladder infection. Bladder infections rarely cause patients to say in the hospital for any additional time.

Bleeding

Heparin-Heparin is commonly used to thin the blood during surgery to prevent blood clotting and pulmonary embolism. Heparin is very useful at preventing pulmonary emboli, however, as stated before, it thins the blood and can cause the patient to bleed during surgery.

Pulmonary Embolism-Pulmonary emboli usually form in the legs and travel to the lungs and/or heart. These can occur at any time, but are more likely in obese patients, and especially during and after surgery because after surgery, most patients don’t like to move around or exercise their legs. The blood sits there in the veins, not moving, then forms clots. Sometimes the clots break off and travel through the veins to the lungs. This is called a pulmonary embolism. The clot blocks the arteries in the lungs and can cause part of the lung to die. This is called a pulmonary infarction. If the circulation to a large part of the lung is cut off, that places the heart under a lot of strain and it may fail suddenly. This can be fatal.

Many surgeons try to prevent their patients from developing pulmonary emboli by 1) giving the patient heparin; 2) giving the patient elastic stockings to wear on their legs after surgery (The elastic stockings are tight and they help compress the legs and keep the blood flowing faster in the veins.); and 3) getting the patient up and walking as soon as possible after surgery is complete.

Hemorrhage-Blood vessels are cut during surgery, and if they’re not tied closed or cauterized properly, it is possible for a patient to begin bleeding either inside the abdomen or at skin level several hours after completion of the operation. This problem is usually easily remedied, but sometimes requires a second trip to the operating room to fix.

Blood Transfusions-When a patient loses too much blood, the pulse and blood pressure tend to become unstable, and the patient may need to have a blood transfusion. Blood from the blood bank is very safe. However, there is a possibility of the patient getting hepatitis, and a very small risk (1 in 500,000) of the patient receiving the AIDS virus. If you prefer, you can donate your own blood (known as “augologous”) to be used during your surgery. This costs approximately $125 per pint. The likelihood of needing this blood during surgery is very low, and so this probably isn’t very economically sound.

Lung Problems

Pneumonia-Pneumonia is a lung infection, and it can be especially dangerous because the organisms that cause the infection can come from the gastrointestinal (“GI”) tract. Many surgeons clean out the GI tract ahead of time, use antibiotics during surgery, and prescribe breathing treatments following surgery.

Atelectasis-Atelectasis occurs when a part of the lung collapses. This happens when the lung isn’t used enough (not enough deep breathing). The best treatment is to prevent it from happening in the first place by doing deep breathing and lung exercises. Atelectasis can also cause a fever and lead to developing pneumonia after surgery.

Bowel Problems

Bowel Obstruction-A bowel obstruction occurs when adhesions form in the abdomen after surgery. Adhesions are scars that look like strands of latex, and can get stuck on a piece of your bowel. Sometimes after the operation (often times, many years after the operation) the bowel becomes kinked around an adhesion and becomes obstructed so that nothing can pass through. It is very important to relieve this obstruction before the bowel loses its blood supply and dies.

Occasionally the patient develops a bowel obstruction soon after surgery. In this case, the adhesions are softer and will fix themselves if conditions are right.

Leakage of Bowel Connections-When bowel is connected to bowel, the connection is called an anastamosis. If it does not form a complete seal, the contents of the bowel can leak out causing a very serious infection. Accompanying this infection is swelling, rapid pulse, and sometimes an abscess.

If drainage isn’t already present, a drain is often put in, taking out the infected fluid from the body cavity. In some cases, emergency surgery is needed to correct this problem.

Obstruction of the Stomach Outlet-During the gastric bypass surgery, when the stomach is connected to the bowel, the opening is deliberately made small to slow how fast the food leaves the new stomach pouch. After surgery when healing begins, scar tissue forms and may contract, causing the opening between the stomach and bowel to become too small, and not allowing food to pass through. This causes repeated vomiting and must be corrected.

Nutritional Problems

Protein Deficiency-A protein deficiency occurs when the patient does not consume adequate amounts of protein to keep the muscles, organs, heart and brain functioning properly. Since gastric bypass surgery reduces the capacity of the stomach, it is extremely important to carefully eat protein-containing foods with each meal. If the first half of the meal is taken as protein-containing foods, deficiency is very unlikely to happen. Some surgeons prescribe protein supplements or drinks for their patients.

Vitamin Deficiency-Once again, since gastric bypass surgery greatly reduces the capacity of the stomach, patients aren’t able to consume the recommended daily amount of vitamins in one day. Because of this, a high potency multivitamin supplement must be taken daily for the rest of the patient’s life.

Also, some patients will develop a deficiency of Vitamin B-12, even while taking the daily multivitamin supplement. This happens because Vitamin B-12 is absorbed mainly in the stomach and duodenum, which are largely bypassed with this surgery. Many surgeons opt to prescribe a sub-lingual B-12 tablet once a week. In some cases, patients have to take B-12 injections.

Mineral Deficiency-The recommended daily multivitamin supplement contains minerals that one’s body needs. Many surgeons also recommend the daily use of calcium, and (in women patients) iron supplements to prevent anemia.

Nutritional problems are rare after gastric bypass surgery providing the patient takes his or her required supplements and eats healthily. This sounds very costly, but in reality, the cost of the needed supplements is roughly only $20.00 per month!

Side Effects of the Gastric Bypass and the Gastric Banding

Side effects occur with any operation, and even though they are less serious than complications, they may be permanent and require a change in lifestyle.

Nausea-After surgery, if a patient gets a full feeling but continues to eat, that patient more than likely will vomit. This usually occurs several times, and most patients quickly learn to follow instructions and eat more slowly and chew their food well. Generally with the gastric bypass, a sense of satisfaction follows the full feeling, and makes the patient indifferent towards eating anything else. With the gastric banding, however, this sense of satisfaction does not occur as quickly or intensely.

For the first few days to weeks following surgery, patients may experience a different type of nausea. This nausea happens because of the delayed function of the Y-limb, and resolves itself suddenly over time. If the patient experiences this type of nausea, it is important to suppress it with anti-emetics because persistent vomiting can cause the patient to become dehydrated and suffer from vitamin deficiencies since vitamin supplements cannot be taken (due to the vomiting).

Food Intolerance

Red Meats-After gastric bypass and gastric banding, red meats are generally not tolerated well, and may cause vomiting. Your stomach cannot tell steak from chicken, except steak is much harder to break down so that it will fit through the small outlet, so this is purely a mechanical effect. If the outlet gets blocked, vomiting will occur. Many surgeons advise their patients to avoid red meat for several months after surgery, or in some cases, altogether.

Sugar-After gastric bypass surgery (but not gastric banding) a condition known as “dumping syndrome” may occur when sugar is eaten on an empty stomach. Refined sugar and candy draw fluid into the intestine and causes the patient to “dump”. The patient turns ghostly white, sweats profusely, has a “butterfly” feeling in his or her stomach, a rapid pulse, feels nauseous and often has terrible cramps, diarrhea and then vomits. Dumping is said to be such a horrible experience that patients who experience it one time never try to sneak another candy bar or cookie again.

Dumping not only occurs when patients try to sneak sugary junk food though-often times foods that are allowed after surgery (certain salad dressings, barbecue sauce, fruit juices, etc.) contain added sugar without the patient knowing. That is why it is extremely important to read labels and make sure you don’t buy anything with added sugar!

Milk and Milk Sugar-After surgery, many patients become lactose intolerant because to digest milk sugar, our bodies need to produce something called lactase. Lactase is often in short supply in the lower small intestine, and therefore milk and milk products may not be fully digested. As they move along farther into the small intestines and then into the large intestines, they are fermented by bacteria, causing cramps, gas and diarrhea. Many patients drink lactose-free milk, but this does not always help. It is probably best to avoid milk altogether after surgery.

Changed Bowel Habits

After restrictive surgery, patients consume much less food, and the amount of roughage eaten may be much smaller. This causes less frequent bowel movements and, sometimes, constipation. Stool softeners may be used to correct this problem.

Hair Loss

After surgery, and during rapid weight loss, the body consumes much fewer calories than it needs, and protein intake is marginal. The body begins to panic, and one of the side effects in some patients is loss of 30% to 40% (rather than the normal 10%) of that patient’s hair. This is a transient effect, and resolves when nutrition and weight stabilize. It is wise to avoid perms and other hair treatments, and be sure to take in adequate amounts of protein. Some people say that zinc supplements and Minoxidil will help, but it has not been proven.

Muscle Mass Loss

Also during the body’s panicked state (trying to combat starvation), it holds on to all the fat it can until any other usable fuel has been burned up. Your body would rather burn muscle than fat! If you don’t exercise your muscles regularly (every day) your body will burn them, causing you to lose your muscle mass, which is not good.

This can be prevented by exercising vigorously every day. It is recommended to do at least 20 minutes of aerobic activity every day. Many people find that after exercising regularly for a few weeks or months that they actually start to enjoy it, and start working out even more. Exercising fairly vigorously for more than 30 minutes per day can greatly enhance fat burning and help you lose weight faster. It also gives you a nice body too. ;o)

Pregnancy

After losing a large amount of weight, many previously infertile women suddenly become fertile. Why? Because fatty tissue soaks up normal hormones and causes lack of ovulation. As women lose weight, this can change quickly.

It is important to be especially careful during your phase of rapid weight loss (about one year after surgery) to avoid conception so that your body can maintain adequate nutrition.

Once you have lost weight and your nutrition is stable, pregnancy is probably not going to cause you any problems, and will more than likely be safer than it would have been if you had become pregnant while obese.

Benefits of Surgical Weight Loss

High Blood Pressure-About 70% of patients who have high blood pressure and take medications to control it can stop taking the medications after surgery as their blood pressure returns to a normal range. This usually occurs two to three months following surgery.

High Cholesterol-Over 80% of patients with high blood cholesterol will develop normal cholesterol levels within two to three months following surgery.

Heart Disease-Although heart disease can’t definitively be reduced, the improvement in heart problems such as high blood pressure, high blood cholesterol and diabetes suggests that improvement in risk is highly likely.

Diabetes Mellitus (adult onset diabetes)-Over 90% of Type II diabetics obtain excellent results within a few days after surgery. Their blood sugars and hemoglobin levels return to normal, and they are freed from taking all their medications, including insulin injections.

Even “borderline diabetes” is more reliably reversed by gastric bypass. Since borderline diabetes often develops into diabetes in many cases, this surgery quite often prevents diabetes.

Asthma-Many asthmatics find that after surgery, they have fewer and less severe attacks. When asthma is associated with GERD, it is particularly benefited by surgery.

Respiratory Insufficiency-Within the first few months following surgery, improvement of exercise tolerance and breathing ability usually occurs. Many times, patients who could barely walk before surgery find that they are able to participate in family activities, and oftentimes, sporting events.

Sleep Apnea-As patients lose weight, relief of sleep apnea occurs. Many patients report that within a year following surgery, their sleep apnea symptoms are completely gone, and that they had even stopped snoring.

Gastro Esophageal Reflux Disease (GERD)-Relief of symptoms of GERD usually occur within a few days of surgery for nearly all patients suffering with it.

Gallbladder Disease-Some surgeons remove the gallbladder during surgery, thus curing that patient’s gallbladder disease. For those who opt to leave the gallbladder in place, there is a slightly increased risk of developing gallstones following surgery. Occasionally, removal of the gall bladder is necessary at a later time.

Stress Urinary Incontinence-This condition is usually completely controlled following surgery. If a person is still troubled after having surgery, that person can elect to have specific corrective surgery later.

Back Pain, Degenerative Disk Disease, and Degenerative Joint Disease-Patients usually experience significant relief of pain from degenerative arthritis and disk disease, and from the weight-bearing joints. This tends to occur early, with the first 25 to 30 pounds lost. If there is nerve irritation or structural damage already present, it may not be reversed by weight loss, and some pain can persist.