Weight Loss Surgery Risks and Benefits
It's all about balancing your risks against your benefits. The key question is weighing the benefits to be gained from surgery, against the risks that one must go through, in order to safely have a weight loss surgery procedure. Usually, the risks are taken right away, when the surgery is performed, and the benefits take a while to pay you back in the form of improved health, reduced long-term risk of illness, and enhancement of your lifestyle.
It’s a personal decision, as well as a medical one. Your doctors can teach you about the risks, and help you measure the likelihood of benefits, and will tell you frankly, if they are out of balance for your condition. Still, the final decision is up to you. To make it intelligently, you need to know about the risks, and the benefits, of the weight loss surgery.
SECTION TOPICS
Risks and Complications of Surgery
The risk of a weight control operation is mainly the risk of having any abdominal operation. In fact, having laparoscopic surgery to install a LAP-BAND® System is often less risky than having your appendix removed. Severely obese persons are well known to be at a disadvantage, when having surgery, and their risks are higher than they would be at a normal body weight. Most bariatric surgery patients will not experience any complications related to their procedures. However, a small degree of risk, including death, is inherent to all types of surgery and use of anesthesia. Because restrictive procedures are less complicated than combined procedures, they are generally safer and result in fewer complications.
The risk of surgery comes mainly from its complications: things can go out of control, causing serious problems, often without any good reason. Having an abdominal operation places a lot of stress on the body. It creates an open wound, which can bleed or fail to heal, and it opens the door to potential infection. The emergency reaction of the body to injury can itself be harmful, when it leads to reactions such as increased clotting of blood, which can cause a fatal pulmonary embolism. Mortality is of course the biggest risk which we will discuss next.
Mortality is the risk of death of a given person based on factors such as age, health, gender, and lifestyle. The investigational TV show 60 Minutes recently reported that the mortality rate among patient undergoing bariatric surgery used to be about 1 in 100, but today it is much less - making weight loss surgery less deadly than most major surgeries.
A study by Duke University Medical Center found the following five risk factors substantially increase your mortality rate; patients with four of them are on average six times as likely to die as those with only one:
- Body mass index. Patients with a BMI of 50 or more are at greatest risk.
- Gender. Men are more likely than women to suffer from conditions such as hypertension, diabetes, and metabolic disorders that can increase surgical risks.
- Age. Older patients, particularly the elderly, are known to be at higher risk for death after bariatric surgery.
- Hypertension. Patients suffering from high blood pressure typically have heart disease or chronic inflammation of blood vessels that can add to the risks of surgery.
- Pulmonary embolus risk. People who have had a blood clot in the lungs, or who are at increased risk for developing such a clot, are at elevated risk.
In the scoring system, patients with none or one of the five medical factors are considered low-risk; those with two or three factors are considered medium-risk; and those with four or five factors are considered to be at the highest risk. This is where the balancing of you risks vs. benefits requires the help of your surgeon to determine whether surgery is the right treatment for your condition. If you decide to put off surgery while you attempt other weight-loss therapies that ultimately don't work, over time you risk moving into a higher-risk category as you may gain more weight, get older or develop hypertension. And in such a case, can make surgery even riskier.
For patients at highest risk, the best approach may be for them to spend some time losing weight before the surgery. Alternatively, we could perform a series of smaller, and therefore less risky, procedures such as the sleeve gastrectomy ultimately ending up with the full gastric bypass surgery.
Roux-en-Y Gastric Bypass complications:
Roux-en-Y gastric bypass surgery is a major operation, some patients may experience some type of postoperative complication.
Most complications are minor, including urinary tract infection, muscle spasms of the abdominal wall, and nausea, but more significant complications can happen.
- Mortality rate: 0.5% (world wide, individual doctor's rate vary greatly)
- Bleeding (from the surgery itself)
- Infections (from the surgery itself)
- Leaks/separation of staple lines
- Follow-up surgeries to correct complications, or to remove excess skin
- Gallstones due to significant weight loss in a short amount of time
- Gastritis (inflammation of the lining of the stomach)
- Vomiting from eating more than the stomach pouch can hold
- Iron or vitamin B12 deficiencies (if they occur) can lead to anemia
- Calcium deficiency (if it occurs) can contribute to the development of early osteoporosis or other bone disorders
Follow up surgeries may be less likely if gastric bypass is performed with a laparoscope (minimally invasive surgery).
Another common complication from gastric bypass is "dumping syndrome." The symptoms often include:
- Nausea and vomiting
- Diarrhea
- Bloated feeling
- Dizziness
- Sweating
You can lessen these symptoms by following your dietitian's guidelines very carefully, especially during the first two months after surgery.
Gastric Banding also known as LAP-BAND® procedure complications:
The most frequent risks associated with the LAP-BAND® procedure are:
- Mortality rate: 0.05% (world wide, individual doctor's rate vary greatly)
- Bleeding (from the surgery itself)
- Infections (from the surgery itself)
- Digestive tract blockage due to band slippage
- Displacement of the port used to adjust the band
- Stomach injury
- Nausea and vomiting
- Stoma obstruction
Other risks include:
Gallstones
Several studies have shown that people who experience significant weight loss can develop gallstones. Although many people with gallstones suffer no adverse effects and may not even know they have them, some surgeons opt to remove the gallbladder during gastric bypass surgery to eliminate this possible complication.
Because removal of the gallbladder during a gastric bypass procedure can be complicated, any potential benefits may be outweighed by risks. Patients who have or are prone to having problematic gallstones should raise this issue with their physician before deciding upon bariatric surgery. These patients may benefit from gallbladder removal or gallstone-dissolving medications.
Suicide
People who undergo bariatric surgery have a higher than normal risk of suicide, according to a 2007 report in the Archives of Surgery. Most of the suicides reported occurred at least a year after surgery. The cause may be an underlying depression that existed before the operation, but the report shows that it may be important for patients to receive psychiatric evaluation before surgery.
This site will provide valuable information about the benefits and risks of weight loss surgery. However, the best way to get a full assessment of your condition is to schedule a consultation to determine if weight loss surgery may be an option for you.
Benefits of Surgical Weight Loss
In our section about understanding obesity, we listed problems, or co-morbidities, which affect most of the organs in the body. The remarkable and wonderful fact is that most of these problems can be greatly improved, or will entirely resolve, with successful weight loss. Most people have actually observed this, at least for short periods, after a weight loss by dieting. Unfortunately, with dieting, such benefits usually do not last, because diets are not effective for long term weight loss.Now let's look at the health benefits of weight loss:
Weight Loss Results after Laparoscopic Gastric Bypass:
- High Blood Pressure
Often at least 70% of patients who have high blood pressure, and who are taking medications to control it, are able to stop all medications and have a normal blood pressure, usually within 2 – 3 months after surgery. When medications are still required, their dosage can be lowered, with reduction of their annoying side-effects.
- High Blood Cholesterol
Usually over 80% of patients will develop normal cholesterol levels within 2 – 3 months after operation.
- Heart Disease
Although we can't say definitively that heart disease is reduced, the improvement in problems such as high blood pressure, high blood cholesterol, and diabetes certainly suggests that improvement in risk is very likely. In one recent study, the risk of death from cardiovascular disease was profoundly reduced in diabetic patients, who are particularly susceptible to this problem. It may be many years before further proof exists, since there is no easy and safe test for heart disease.
- Diabetes Mellitus
Over 90% of Type II diabetics obtain excellent results, usually within a few days after surgery as evidenced by the Gastric Bypass surgery a cure for diabetes video to the right: normal blood sugar levels, normal Hemoglobin A1C values, and freedom from all their medications, including insulin injections. Based upon numerous studies of diabetes and the control of its complications, it is likely that the problems associated with diabetes will be arrested in their progression, when blood sugar is maintained at normal values. There is no medical treatment for diabetes which can achieve as complete and profound an effect, as weight loss surgery - which has led some physicians to suggest that surgery may be the best treatment for diabetes, in the seriously obese patient.
Abnormal Glucose Tolerance, or "Borderline Diabetes" is even more reliably reversed by gastric bypass. Since this condition becomes diabetes in many cases, the operation can frequently prevent diabetes, as well. - Asthma
Most asthmatics find that they have fewer and less severe attacks, or sometimes none at all. When asthma is associated with gastroesophageal reflux disease, it is particularly benefited by gastric bypass.
- Respiratory Insufficiency
Improvement of exercise tolerance and breathing ability usually occurs within the first few months after surgery. Often, patients who have barely been able to walk, find that they are able to participate in family activities, even sports activities.
- Sleep Apnea Syndrome
Dramatic relief of sleep apnea occurs as our patients lose weight. Many report that within a year of surgery, their symptoms were completely gone, and they had even stopped snoring completely – and their spouses agree.
- Gastroesophageal Reflux Disease
Relief of all symptoms of reflux usually occurs within a few days of surgery, for nearly all patients. It is believed that the changes in the esophageal lining membrane, called Barrett's esophagus, may be reversed by the surgery as well – thereby reducing the risk of esophageal cancer.
- Gallbladder Disease
When gallbladder disease is present at the time of the surgery, it is "cured" by removing the gallbladder during the operation. If the gallbladder is not removed, there is some increase in risk of developing gallstones after the surgery is performed, and occasionally, removal of the gallbladder may be necessary at a later time.
- Stress Urinary Incontinence
This condition responds dramatically to weight loss, usually by becoming completely controlled. A person who is still troubled by incontinence can choose to have specific corrective surgery later, with much greater chance of a successful outcome, with a reduced body weight.
- Low Back Pain and Degenerative Disk Disease, and Degenerative Joint Disease.
Patients usually experience considerable relief of pain and disability from degenerative arthritis and disk disease, and from pain in the weight-bearing joints. This tends to occur early, with the first 25 -30 pounds lost, usually within about a month after surgery. Of course, if there is nerve irritation, or structural damage already present, it may not be reversed by weight loss, and some pain symptoms can persist.
A Final Note on Patient Safety
In a study released: January 09, 2008 by the Office of Health and Human Services (EOHHS) Department of Health; Commissioner John Auerbach said "Overwhelming new data highlighted in this report demonstrate reductions in known disease risk factors, improvements in health, and significant reductions in mortality after weight loss surgery.” The expert Panel on Weight Loss Surgery released this six-month effort which involved over 100 specialists from the across the state and across the many disciplines involved in the field of weight loss surgery. The Expert Panel included a consumer representative and leading authorities in the fields of obesity treatment, patient safety, nutrition, medical practice, managed care, pediatrics, nursing, and ethics. It was chaired by George L. Blackburn, M.D., Ph.D., from Beth Israel Deaconess Medical Center. Matthew Hutter, M.D., from Massachusetts General Hospital served as the Panel’s Vice Chair. Dr. Blackburn explained that the panel used a state-of-the-art model of evidence-based medicine to develop its findings.
So it is clear that scientific data and leading experts agree that weight loss surgery is a proven tool to use in the effort to establish long term weight loss and improved health for those who are morbidly obese. But what surgical options are available and which procedure is best for you? We look in to this question in the next section called weight loss surgery options.
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