Risks of Bariatric Surgery

Bariatric surgery is major surgery, even with minimally invasive surgical techniques. The operation requires general anesthesia, at least two to four days of hospitalization, and several weeks of physical recovery. Furthermore, as with any major operation, there are risks.

General Risks

All abdominal operations carry these risks:

• bleeding
  
  
• infection in the incision
  
  
• potential problems with the heart and/or lungs
  
  
• obstruction (blockage) of the intestine caused by adhesions
  
  
• hernia through the incision; rejection of suture materials
  
  
• risks associated with general anesthesia (these risks are not significantly greater in most morbidly obese patients than in normal-weight patients)
  
  

Risks of Gastric Restrictive Operations

	What are the greatest risks associated with gastric bypass surgery?
	Potentially fatal risks include leaks from the stomach or intestine and embolism (blood clots). The chances of these complications occurring are between 1% and 2%. The risk of death associated with bariatric surgery is less than 1%.

1. Leakage of fluid from the stomach or intestine through the staples or sutures which results in abdominal infection. This potentially serious (but rare) complication usually requires a second operation for drainage of infection.
   
   
2. Injury to spleen. This is a very uncommon complication which may require removal of the spleen if bleeding cannot be controlled.

The incidence of early postoperative complications is under 5% for both bariatric procedures.

1. The formation of ulcers in the stomach or small intestine. This is an uncommon complication which occurs in approximately 4 out of 100 patients after gastric bypass surgery. Ulcers are more common in smokers and patients taking medications for arthritis.
   
   
2. Dumping. Patients may develop loose stools and/or abdominal cramps shortly after eating certain types of foods. These symptoms can be avoided by not eating the offending foods. Diarrhea is uncommon after gastric restrictive surgery and can be successfully treated with medication. Dumping is occasionally associated with brief periods of light-headedness, sweating or heart palpitations due to low blood sugar. These symptoms can usually be reduced by drinking a sweet liquid like fruit juice.
   
   
3. Obstruction of the opening of the stoma. This rare complication occurs in less than 1 out of 100 gastric bypass patients and can occur when a piece of food becomes lodged in the stoma. When this happens, the piece of food is removed through a tube (endoscope) passed from the mouth into the stomach.
   
   
4. Vitamin and/or iron deficiency. This may occur in a mild form in as many as 40 percent of patients after gastric bypass. Iron and some vitamins, most notably Vitamin B-12, are primarily absorbed in the stomach and upper part of the small intestine which is bypassed. Both the vitamin and iron deficiencies are easily treated by either oral supplementation or injections. Women who are regularly menstruating will need additional iron supplements.
   
   Vitamin and iron deficiencies are uncommon after stapled gastroplasty because, with this operation, the food passes through the stomach and small intestine in the normal way.
   
   Low calcium and protein levels and deficiencies in fat soluble vitamins (A,D,E) are known to occur after distal gastric bypass. Gas, flatulence and diarrhea may be more prominent after distal gastric bypass.
   
   
5. Inaccessibility of the lower stomach and upper intestine to diagnostic tests such as upper GI (barium) x-rays and upper GI endoscopy. When the stomach is closed off in a gastric bypass, there is no way for contrast material or an endoscope to reach the bypassed stomach (the part of the stomach below the staples). This would make diagnosis of a problem, such as an ulcer of the lower bypassed stomach, more difficult. The incidence of problems occurring in the bypassed part of the upper GI tract is extremely low.
   
   
6. Staple disruption can occur at any time after these operations but is uncommon. If staples pull out, the feeling of fullness will probably disappear. A second operation may be required (restapling).
   
   
7. Hair loss may be a temporary problem for some patients within the first six to twelve months after the operation. This is largely due to vitamin deficiency. There is no specific remedy other than proper nutrition and multivitamin supplements.