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risks and complications of bariatric surgery

Risks and Complications of Bariatric Surgery
It is very important to understand that:

  1. any surgery carries risks of complications that both the surgeon and the patient wish did not happen.
  2. the more complex the nature of the surgery, the higher is the risk of suffering complications and the more serious the complications may be.
  3. the risk is closely related to the general fitness of the patient undergoing the surgery.
  4. serious complications can result in death
  5. when complications occur, further operations may be required to rectify the problem(s).

Bariatric surgery is complex gastrointestinal surgery done in patients who by virtue of their obesity, as well as any co-morbid diseases, are at high risk for both anaesthesia and surgery.

Complications of surgery can be categorized into:

  1. those directly related to the execution of the operation; these can be subdivided into early and late complications
  2. those not directly related to the surgical procedure – these can occur at any time to anyone, but the stress of surgery increases the risks at the time of surgery and in the post-op period. People undergoing bariatric surgery, with their serious morbidity and various co-morbid diseases, are at significantly higher risks of these complications than a person of normal weight with no co-morbid diseases undergoing major surgery.


Early direct complications:

  1. Haemorrhage:
    1. from staple lines and anastomoses (where bits of bowel are joined together)
    2. from port wounds
    3. from intra-abdominal injuries e.g. to liver, spleen or bowel
       
  2. Leaks:
    1. from staple lines
    2. from anastomoses
    3. from injuries to oesophagus, stomach or bowel
       
  3. Intra-abdominal infections and abscesses:
    1. from leaks or haemorrhages
    2. may lead to systemic sepsis (septicaemia)
       
  4. Obstructions:
    1. due to anastomoses being too narrow
    2. due to kinking or twisting of bowel
    3.  due to previously undiagnosed obstructing pathology in distal bowel
       
  5. Pancreatitis:
    1. sometimes spontaneous
    2. sometimes due to an injury to the pancreas
       
  6.     Skin wound infections and/or dehiscences (separating of the wound or its layers).

Early indirect complications

  1. “Heart attacks” – severe angina attacks, myocardial infarcts and/or heart rhythm disturbances
  2. “Strokes” due to critically reduced blood flow to the brain resulting from:
    1. narrowed arteries, perhaps compounded by a period of low blood pressure
    2. intracerebral haemorrhage, often associated with sudden elevation of blood pressure
    3. migration of a clot (embolus) or atheromatous plaque (debris from artery wall) to the brain.
  3. Pulmonary emboli where blood clots migrate to the pulmonary arteries, occluding blood flow to part(s) of the lung(s)
  4. Pneumonia, usually associated with retention of a mucous plug and collapse of a portion of the lung, with secondary infection
  5. Anaesthetic complications

Late complications and side effects:

  1. Anastomotic ulcers
  2. Bowel obstruction due to adhesions, internal hernias or food bolus obstructions
  3. Incisional Hernias
  4. Internal hernias
  5. Adhesive obstruction
  6. Stricture at anastomoses
  7. Cosmetic: e.g. excess skin
  8. Gallstones: due to significant weight loss in a short amount of time
  9. Nutritional
    1. Vomiting from eating more than the stomach pouch can hold
    2. Anemia: iron or vitamin B12 deficiencies
    3. Calcium deficiency: can contribute to the development of early osteoporosis or other bone disorders
    4. “Dumping syndrome":
      1. this is an unpleasant but essentially harmless sensation characterised by nausea, sweating and faintness
      2. it is usually precipitated by eating a meal with high carbohydrate content and is unlikely to occur if such foods are avoided

Mortality Associated with Bariatric Surgery

The overall mortality rate for bariatric surgery has been quoted as 0.3%.

Of course within the large group of people undergoing bariatric surgery are people with greater and lesser risk factors for surgery, and the different types of operations carry different relative risks. In each individual contemplating bariatric surgery, the risk for that individual has to be assessed.
The whole idea of doing bariatric surgery is to reduce the mortality risk attached to the disease of obesity.

Comparative analyses of long-term follow-up of obese people undergoing bariatric surgery and obese people treated without surgery have confirmed that those undergoing surgery live significantly longer than those not having surgery, despite a few operative deaths.

We strive, therefore, to minimise the risks of surgery and to optimise the fitness of those individuals who plan to undergo surgery, as well as those who, initially, may be an unacceptably high risk.