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RISKS OF SURGERY

The risks associated with weight loss surgery are the same as those for any abdominal operation. Morbidly obese people have an additional disadvantage due to their increased weight and the individual risks are higher than they would be for a person of normal weight. Major complications occur in approximately 1.35% of patients. Minor complications occur in 10 to 20% of all weight loss surgery patients.

Abdominal surgery places stress on the body. Serious problems can occur in some patients and, often they happen for no apparent reason. The body reacts to any surgery as if an injury had occurred. The body's natural reaction can lead to increased clotting of blood. We use a combination of heparin injections and placing pneumatic-compression stockings on the legs. An explanation of the complications associated with abdominal surgery are listed below:

• Abscess: An abscess is a collection of infected fluid which occurs somewhere in the body. After surgery a pocket of fluid may develop and bacteria, if present, may infect it and create an abscess. Abscesses normally occur near the incision line. Treatment for abscesses is to drain away the infected fluid and kill the bacteria with antibiotics.



• Atelectasis: Atelectasis is partial collapse of the lung, caused by lack of motion of the chest wall. Atelectasis can cause a fever after surgery and can lead to pneumonia. Deep breathing, coughing and lung exercises are very important post-operatively as is early walking.



• Bleeding: Heparin is used prevent blood clotting and pulmonary embolisms. If the blood does not clot at all, bleeding can occur. Patients are observed closely for this and heparin is stopped if bleeding becomes a problem.



• Bowel Obstruction: A bowel obstruction is a blockage that prevents food and liquid from moving through the intestine. Partial obstructions are often resolved without surgery. A complete obstruction requires surgery to correct. Bowel obstructions occur in less than 1% of patients undergoing abdominal surgery. The obstruction is caused by adhesions (scars) that form in the abdomen after surgery. They look like strands of latex or fibrous cord and can wrap themselves around a piece of bowel. The bowel then kinks around an adhesion and becomes obstructed.



• Cardiac Problems: Cardiac problems can occur after any surgery. They are more common in patients with a history of heart failure, hypertension, angina, high cholesterol and diabetes. Heart attacks are rare in gastric bypass patients.



• Death: Death can occur as the result of any surgical procedure. The risk of death from Weight Loss Surgery is reported as less than 1% based on several studies. The actual risk varies from patient to patient depending upon medical problems and overall health.



• Hemorrhage: Whenever surgery is performed blood vessels are cut. They are tied off with a ligature or, by using an electrocautery that coagulates the blood, and the end of the blood vessel. Sometimes a blood vessel may escape and begin to bleed causing a hemorrhage either inside the abdomen or at skin level. Hemorrhages must be stopped and there are several strategies to stop the bleeding, but in some rare cases, surgery may be required.



• Hernia: Approximately 15% of weight loss surgery patients develop incisional hernias. An Incisional hernia is the result of a defect in the abdominal wall. While some patients experience no symptoms with hernias others complain of pain, vomiting, diarrhea or constipation. Surgery is required to repair hernias. In some cases emergency surgery may be required if a portion of the intestine becomes entrapped. Otherwise it is best to wait until most of the weight has been lost before having a hernia repaired. It is often possible to have abdominoplasty (tummy tuck) done at the same time.



• Leaks: A leak occurs when the staples or suture line closing off the intestine or new stomach pouch (stoma) connection fail to hold. Fluid from the GI tract leaks into the abdomen and can cause a serious infection. Symptoms of anastomotic leaks include, swelling, rapid pulse rate, shortness of breath, elevated white blood count, disorientation, reduced urine output, or formation of an abscess. A leak is one of the most serious complications and often requires immediate surgery to find the leak and repair it.
  
• Obstruction of Stomach Outlet: Occurs in about 10% of patients. When the new pouch is connected to the bowel the opening is deliberately made small, about ½ inch in diameter, to slow the flow of food into the intestines. Healing occurs by scar formation and scars have a tendency to contract. Sometimes the opening between the new pouch and bowel may become too small. When this happens food can't get through resulting in repeated vomiting. Treatment is usually done with the use of endoscopy. The gastroenterologist uses a balloon attached to the end of the scope to stretch the outlet.



• Pneumonia: Pneumonia is an infection in the lungs. After surgery pneumonia can be serious, because the infecting organisms often come from the gastrointestinal tract, and can be very destructive. Pneumonia is treated with antibiotics, oxygen and respiratory therapy. It can prolong the hospital stay.



• Pulmonary Embolism: Pulmonary embolism occurs in about 5% of WLS patients. It affects the lungs and heart but normally starts in the legs as blood clots. These can occur at any time but are more common at the time of and soon after surgery and can be fatal. Pulmonary embolisms are prevented by thinning the blood with heparin and by placing pneumatic-compression stockings on the legs to compress them and keep the blood flowing. It is important for patients to get up and walk as soon as possible after surgery.



• Urinary Tract Infection: At the time of surgery a catheter is used to help patients void. In rare cases this can cause a bladder infection. Bladder infections are treated with antibiotics.



• Wound Infection: Obese patients are more apt to develop wound infections than normal weight patients. Treatment of wound infections can be time-consuming and increase recovery time. Patients that develop wound infections are at higher risk for developing incisional hernias.