Bariatric Surgery Risks

It’s wise to be informed about the advantages as well as bariatric surgery risks associated with any weight loss procedure of which you are considering.

Gastric Banding

 

 

Intra-operative and/or Immediate Post-operative Risks:

 

Death: The mortality rate of the adjustable gastric band nationwide is around 1 in 1600.

Significant Bleeding: Significant bleeding after an adjustable gastric band is reported to be extremely rare. Bleeding may occur unexpectedly in the operating room or immediately afterwards. A transfusion may be necessary in these rare circumstances. Re-operation to stop bleeding may be necessary.

Stomach or Esophageal Injury: Injury to the stomach or esophagus can cause life-threatening complications including a prolonged hospital stay, a long period of nothing to eat, prolonged antibiotic requirements, organ failure and death. This is a very rare complication.

Organ Failure: In very rare circumstances, organ failure may occur. This may include failure of the kidney, heart, lungs or liver.

Prolonged Hospital Stay: Complications may result in a prolonged hospital stay.

Deep Vein Thrombosis (DVT)/Pulmonary Embolism: Blood clots after an adjustable gastric band are typically uncommon. Blood clots that form in the legs, and elsewhere, and break off into the lungs may cause death.  Given this risk, treatments will be initiated to decrease the risk for the formation of blood clots, including the use of heparin (a medication that thins the blood), special foot and leg stockings, walking soon after surgery and medication at home after discharge from the hospital.  Completely eliminating the risks of DVT (clots) altogether is not medically possible. The risks associated with the medications used to prevent blood clots can include excessive bleeding. Any symptoms of leg swelling, chest pain or sudden shortness of breath should be immediately reported to the surgeon. Rarely, patients develop allergies to heparin, sometimes causing very severe reactions.

When discussing bariatric surgery risks other complications may be common: Allergic reactions, headaches, itching, medication side-effects, heartburn/reflux, bruising, gout, anesthetic complications, injury to the bowel or vessels, gas bloating, minor wound drainage, wound opening, and scar formation. 

Acute Obstruction: Rare patients will not be able to tolerate any liquids or solids immediately after the gastric band is placed. Acute obstruction usually occurs in the first day after surgery and may require a re-operation to loosen the obstruction. There are several possible reasons for obstruction including band slippage, stomach swelling and poor positioning of the band.

Infection: Uncommonly, infections caused by the adjustable gastric band can occur.  Infections caused by prosthetic devices are very difficult to treat with antibiotics alone. Infections of the adjustable gastric band often require removal of the entire system.

Procedure Abortion: Under very rare circumstances, the surgeon may determine that the procedure should be aborted all together. This is most often due to the presence of massive scarring from previous surgeries, or the intra-operative diagnosis of medical problems such as severe liver disease or tumors.

Conversion to Open Procedure: In rare circumstances, the procedure may not be able to be performed laparoscopically. If a conversion to an open procedure is required, complications include but are not limited to wound infection, which may cause significant scarring and healing problems, prolonged wound care, and discomfort. Incisional hernias are not uncommon after an open procedure. Hernias will often require a subsequent operation to repair. There is a higher chance of certain complications including lung infections, pressure ulcers and blood clots after an open operation. There would also likely be more discomfort and a longer hospital stay.

 

Bariatric Surgery Risks include Late Complications:

 

  • Weight regain: Weight regain may occur. This may occur for a number of reasons. No weight loss method is foolproof.
  • Poor Weight Loss: I have discussed with my surgeon the average weight loss that is seen with patients after an adjustable gastric band. I understand that there is no way to predict my own weight loss after the procedure. Weight loss resulting from various surgical weight loss procedures, including the adjustable gastric band, is variable and unpredictable. Some patients lose very little weight after an adjustable gastric band.
  • Slippage: The adjustable gastric band can slip out of position. If this occurs patients may not be able to tolerate any food or even liquids. There may be mild to severe abdominal pain. Urgent repair is often necessary. There are very rare reports of patients who have died from a slipped gastric band that caused the stomach to lose its blood supply.
  • Tubing Problems: During the adjustments performed in the office, it is possible to puncture the tubing accidentally. This would require a minor operation to correct. The tubing of the band can crack on rare occasions. If this occurs, all the fluid leaks out and the patient will experience a complete lack of restriction. This would require a minor re-operation to fix.
  • Adjustment Problems: I have discussed with my surgeon the gastric band adjustment process. My surgeon or another qualified individual will perform my adjustments. I understand that adjustments are either performed in the office or under X-Ray guidance, depending on what my surgeon believes is best for me. I understand that there is no fool-proof method to efficiently adjust my band. I understand that some patients may only need a few adjustments, while others may need numerous adjustments. I understand that my band may be accidentally adjusted too tightly. If this occurs, I will need to contact my surgeon’s office immediately. I understand that my surgeon will only perform an adjustment if it is in my best interest. Over- adjustment (over-tightening)   of the band may cause irreversible problems such as pouch dilation, esophageal dilation, gastro-esophageal reflux, pneumonia and perhaps band slippage. I understand that if I am traveling, I may have difficulty finding a qualified physician who can manage my band. I understand that if I move out of the area, I may encounter difficulty in finding a qualified surgeon to adjust and manage my band. Complications of the adjustment process may include bruising, discomfort, infection or damage to the port or tubing.
  • Pouch Dilation and/or Esophageal Dilation: Dilation of the stomach pouch and/or the esophagus may occur after placement of the gastric band. This complication typically is due to over-adjustment (over-tightening) of the band. Symptoms may include poor weight loss and heartburn. Treatment of this complication may require band deflation, operative repositioning of the band, or band removal.
  • Port Problems: The port can flip out of position. If this occurs, it may be difficult to adjust the gastric band. The only manner to correct a port flip is to perform a procedure in the operating room. In people who lose a significant amount of weight, the port may be seen as an unsightly bump.
  • Erosion: The gastric band may erode a hole into the stomach. If this occurs, a life-threatening infection may ensue. Band removal is the only treatment. This operation may be difficult with possible complications. Erosion is an uncommon complication. Erosions may occur years after the placement of the band.
  • Band Removal: Removal of the gastric band may be needed if the patient experiences complications. Typically, weight regain occurs quickly after band removal. Removal of the band may have complications associated with the removal procedure.
  • Unlisted Complications: I understand that it is impossible to list every complication possible during and after the adjustable gastric band procedure.

 

Possible Additional Procedures:

 

During the adjustable gastric band operation, several conditions may arise that may cause additional procedures to be performed. These include:

  • A liver biopsy: Some patients will need to have a liver biopsy performed. Bariatric patients often have some degree of liver disease. A biopsy helps determine the severity of liver disease (if present at all) and helps with post-operative management. The risks with performing a liver biopsy include a low chance of bleeding.
  • Hiatal Hernia repair: If a hiatal hernia is present, it will require repair during the surgery. The associated risks with a hiatal hernia repair include, but are not limited to, injury to the esophagus, dysphagia (difficulty swallowing) and hernia recurrence.
  • Lysis of Adhesions: In the setting of a previous operation or significant abdominal infection, scarring always results. The degree of scar tissue is unpredictable. Sometimes, depending on the location of the scar tissue, the scar tissue must be cut (called “lysis of adhesions”) in order to perform the weight loss operation. There are increased risks when a lysis of adhesions is necessary, including injury to the intestines, prolonged operative times and bleeding.
  • Other undesirable outcomes: Not all patients lose all the weight they hope to.  Most commonly, weight loss fails when patients fail to work with the surgery to dramatically reduce their calorie intake and establish a regular exercise program.  Most patients will be left with excess skin on the abdomen, arms, legs, or other areas.  This skin may be unattractive, and may cause pain or hygiene problems.  Unfortunately, the excess skin usually does not “snap back” with exercise or time – and sometimes must be removed by additional surgery. 

    You are being offered the AGB because your surgeon believes it is a medically reasonable option in your case.  Your part of the decision to undergo surgery is more complex and more important.  While the purpose of the operation is to improve the patient’s health, any of the above or other unforeseen complications may occur; and despite the best medical care, can result in complications or death.

 

Sleeve Gastrectomy

 

 

Intra-operative and/or Immediate Post-operative Risks:

 

  • Death: With any surgical procedure, there is always a risk of death.
  • Significant Bleeding: Significant bleeding after a laparoscopic sleeve gastrectomy is reported to be extremely rare. Bleeding may occur unexpectedly in the operating room or immediately afterwards. A transfusion may be necessary in these rare circumstances. Re-operation to stop bleeding may be necessary.
  • Stomach or Esophageal Injury: Injury to the stomach or esophagus can cause life-threatening complications including a prolonged hospital stay, a long period of nothing to eat, prolonged antibiotic requirements, organ failure and death. This is a very rare complication.
  • Gastric Leak: The most devastating complication from a gastric sleeve is a leak from the staple line which could lead to an infection inside the abdomen. This can be very serious, and can lead to chronic problems and, potentially, death. Treatment may require additional procedures and/or another operation.
  • Reflux: Symptoms of acid reflux (heartburn) can worsen in approximately 10% of patients. However, symptoms are also improved in many patients. Approximately 70% of obese patients have hiatal hernias which are well known to contribute to reflux disease. At the time of surgery, if a hiatal hernia is discovered it will be repaired.
  • Organ Failure: In very rare circumstances, organ failure may occur. This may include failure of the kidney, heart, lungs or liver.
  • Prolonged Hospital Stay: Complications may result in a prolonged hospital stay.
  • Deep Vein Thrombosis (DVT)/Pulmonary Embolism: Blood clots after a sleeve gastrectomy are typically uncommon. Blood clots that form in the legs, and elsewhere, and break off into the lungs may cause death.  Given this risk, treatments will be initiated to decrease the risk for the formation of blood clots, including the use of heparin (a medication that thins the blood), special foot and leg stockings, walking soon after surgery and medication at home after discharge from the hospital.  Completely eliminating the risks of DVT (clots) altogether is not medically possible. The risks associated with the medications used to prevent blood clots can include excessive bleeding. Any symptoms of leg swelling, chest pain or sudden shortness of breath should be immediately reported to the surgeon. Rarely, patients develop allergies to heparin, sometimes causing very severe reactions.
  • Other Complications that may be common: Allergic reactions, headaches, itching, medication side-effects, heartburn/reflux, bruising, gout, anesthetic complications, injury to the bowel or vessels, gas bloating, minor wound drainage, wound opening, and scar formation. 
  • Procedure Abortion: Under very rare circumstances, the surgeon may determine that the procedure should be aborted all together. This is most often due to the presence of massive scarring from previous surgeries, or the intra-operative diagnosis of medical problems such as severe liver disease or tumors.
  • Conversion to Open Procedure: In rare circumstances, the procedure may not be able to be performed laparoscopically. If a conversion to an open procedure is required, complications include but are not limited to wound infection, which may cause significant scarring and healing problems, prolonged wound care, and discomfort. Incisional hernias are not uncommon after an open procedure. Hernias will often require a subsequent operation to repair. There is a higher chance of certain complications including lung infections, pressure ulcers and blood clots after an open operation. There would also likely be more discomfort and a longer hospital stay.

 

Late Complications:

 

Weight regain: Weight regain may occur. This may occur for a number of reasons. No weight loss method is foolproof.

Poor Weight Loss: I have discussed with my surgeon the average weight loss that is seen with patients after a sleeve gastrectomy. I understand that there is no way to predict my own weight loss after the procedure. Weight loss resulting from various surgical weight loss procedures, including the sleeve gastrectomy, is variable and unpredictable. Some patients lose very little weight after a sleeve gastrectomy.

Pouch Dilation and/or Esophageal Dilation: Dilation of the stomach sleeve may occur. This complication typically is due to over eating and stretching of the stomach sleeve. Symptoms may include poor weight loss and heartburn. Treatment of this complication may require another operation.

Vitamin Deficiencies:  Because a large portion of the stomach is removed, patients may have a problem absorbing vitamin B-12. To avoid this risk, we place patients on daily multivitamins high in vitamin B-12.

Unlisted Complications: I understand that it is impossible to list every complication possible during and after the sleeve gastrectomy procedure.

 

Bariatric Surgery Risks may include the need for Additional Procedures:

 

During the sleeve gastrectomy operation, several conditions may arise that may cause additional procedures to be performed. These include:

  • A liver biopsy: Some patients will need to have a liver biopsy performed. Bariatric patients often have some degree of liver disease. A biopsy helps determine the severity of liver disease (if present at all) and helps with post-operative management. The risks with performing a liver biopsy include a low chance of bleeding.    
  • Hiatal Hernia repair: If a hiatal hernia is present, it will require repair during the surgery. The associated risks with a hiatal hernia repair include, but are not limited to, injury to the esophagus, dysphagia (difficulty swallowing) and hernia recurrence.
  • Lysis of Adhesions: In the setting of a previous operation or significant abdominal infection, scarring always results. The degree of scar tissue is unpredictable. Sometimes, depending on the location of the scar tissue, the scar tissue must be cut (called “lysis of adhesions”) in order to perform the weight loss operation. There are increased risks when a lysis of adhesions is necessary, including injury to the intestines, prolonged operative times and bleeding.
  • Other undesirable outcomes: Not all patients lose all the weight they hope to.  Most commonly, weight loss fails when patients fail to work with the surgery to dramatically reduce their calorie intake and establish a regular exercise program.  Most patients will be left with excess skin on the abdomen, arms, legs, or other areas.  This skin may be unattractive, and may cause pain or hygiene problems.  Unfortunately, the excess skin usually does not “snap back” with exercise or time – and sometimes must be removed by additional surgery.

You are being offered the LSG because your surgeon believes it is a medically reasonable option in your case.  Your part of the decision to undergo surgery is more complex and more important.  While the purpose of the operation is to improve the patient’s health, any of the above bariatric surgery risks or other unforeseen complications may occur; and despite the best medical care, can result in complications or death.

Please fill out our contact us form or call us at 727-289-7137 to learn more about how Sun Coast Bariatrics can help you today.