One of the most important things that cause an obese patient to not have a bariatric procedure is because he/she is “afraid that something might happen”. It is true that every surgery might have complications and bariatric surgery is not the exception. However, it is very important to be aware of the risks of staying obese, which are far more numerous than those from surgery. Besides, bariatric procedures have never been safer.
At Obesity Health, we make sure you learn about the possible complications, the possibilities of having them and how we proceed if it happens.
a) Surgical site infection: Considered a minor complication, 3 out of 100 post-op patients will have it. This is frequently caused by an improper wound care after the surgery. It is usually resolved by prescribing antibiotic for a few extra days and, in some cases, reopening the wound site (1 cm/0.3 in) to allow it to heal correctly.
b) Bleeding: Sometimes one of the arteries or veins inside the abdomen bleed after the surgery. One out of 100 patients will have it. We would be able to identify it because blood will start to come out of your drain. If this happens, the laparoscopic camera would need to be placed inside your abdomen to see the bleeding vessel and place a staple. This complication is usually easy to correct.
c) Stenosis or torsion: It could happen because whether the scar tissue formation inside the stomach is excessive and obstructs the liquid passage or because the stomach twists as a result of a bad movement. For bypass surgery this complications can occur in the bowel. This is a very rare complication only 1 out of 100 patients have it. Treatment consists in resting, placing an endoscope, more than once, to remove the obstruction or in extreme cases need a new surgery.
d) Intra-abdominal organ injury: Sometimes there are technical difficulties during the surgery, and the surgeon unintentionally injures an organ (such as the spleen or bowl). This complication is associated with a bad pre-op diet, which causes the procedure to have even more technical difficulties. One to two out of 500 cases have had it. It is managed right away by closing the bowl, taking out the spleen or even converting the surgery to an open procedure.
e) Leak: One of the most feared complications, when one of the staples we use to form your new stomach or the anastomosis comes loose. This happens when making an extreme effort, a bleed that pushes the staple, or simply by bad scaring of the tissue. This requires an immediate treatment. Most cases can be handled with an endoscopic stent and a feeding tube to the bowl to let the stomach rest for 3-6 weeks. Parenteral nutrition, prolonged hospitalization and reoperations are rarely needed. This complication presents itself in 1-2 out of 100 post-op patients.
f) Pulmonary embolism: It is an extremely rare complication in young patients (less than 50 years old) with a BMI between 35-50 and with no comorbidities. It presents itself in 1-2 out of 1000 patients. On the other hand, the risk increases with patients over 60 years old and with a BMI over 50, a history of thrombosis and a bad-managed diabetes.
g) Surgery conversion: It is not really considered a complication but rather a different approach. In some cases, it will be necessary to convert the procedure to an open surgery, that is, a bigger incision on the center of the abdomen. Most cases are caused by bleeding that cannot be controlled laparoscopically although other causes may exist. Literature reports this complication in 1-2 out of 100 cases. In our years of practice, we have never had to convert the surgery.
SPECIFIC COMPLICATIONS OF BYPASS AND MINI BYPASS
h) Internal hernias: This complications is produced when the bowel or intrabdominal fat is trapped into a defect generated durign the surgery. This complications presents in 1-2 out of 100 post-op patients. Most cases improve with resting, however, in some cases laparoscopic surgery will be needed.
i) Marginal ulcers: Ulcer(s) that forms in the anastomosis between the new stomach and the jejunum, it can cause discomfort. Most cases are treated with medications (omeprazole, esomeprazole) and diet. Sometimes upper endoscopy or laparoscopic surgery will be needed.
As previously mentioned, it is very important that the patient knows the possible complications might have and what to do in case of presenting them but it is also important that the patient be aware that the risk of having a complication is much less than having associated disease or complication related to obesity.
Please contact us if you need more information regarding complications.