In a consensus paper written for the journal Surgery for Obesity and Related Diseases, Dr. Henry Buchwald points out that about a third of Americans are obese. Obesity is considered a chronic disease and a risk factor for many other diseases such as hypertension, hardening of the arteries, stroke, sleep apnea, diabetes, muscle strain, fatty liver disease and psychological disorders. Obesity has been successfully treated with bariatric surgery, a procedure that essentially restricts or limits the amount of calories that a person can take in. Like all surgeries, bariatric surgery does not come without risk.
Gastric Remnant Distension
The Roux-en-Y procedure involves the creation of a gastric pouch and a bypass of part of the small bowel, so that intake and absorption are restricted. This procedure is the most common procedure for gastric bypass surgery and can be done by using a laparoscope or by cutting open the abdomen. Gastric remnant distension is a rare but potentially fatal complication. The gastric remnant, or what is left of the stomach after this surgery, can become severely distended if paralytic ileus, which is a slowing of the emptying of the intestines, or a mechanical obstruction occurs. Ultimately gastric remnant distension can lead to rupture of the stomach. Symptoms include pain, hiccups, shoulder pain, abdominal distension, fast heart rate and shortness of breath. This requires emergency intervention.
Stomal Stenosis
Dr. Daniel Jones and Jamie Adair note in their online article, "The Complications of Bariatric Surgery," that 6 to 20 percent of patients who undergo a Roux-en-Y procedure can develop stomal stenosis. This means that the hole that is created in the stomach becomes too small, and the stomach cannot pass its contents through it. This can appear several weeks after surgery. Symptoms include nausea, vomiting, difficulty swallowing, and indigestion. Usually endoscopic balloon dilation is successful in treating this complication.
Gallstones
Gallstones form in as many as 38 percent of patients within six months of bariatric surgery. Close to half of these patients become symptomatic. These patients require gallbladder surgery to remove the gallbladder.
Stomal Obstruction
Laparoscopic adustable gastric band surgery, or LAGB, is a restrictive procedure that uses silicone bands around the entrance of the stomach to restrict the amount of food consumed. These bands can be adjusted through a subcutaneous port connected to the band. Fourteen percent of LAGB patients develop an early complication called stomal obstruction. This obstruction occurs when excess tissue in the gastric bands or significant swelling of the tissue surrounding the bands makes the band too tight. Patients will typically have nausea, vomiting and inability to tolerate oral intake. This complication may require a nasogastric tube for stomach decompression.
Band Erosion
Erosion of the bands through the wall of the stomach in LAGB has been reported in up to 7 percent of patients. This is a late complication and can occur as late as 22 months after surgery. This occurs because the band is excessively tight. Infection, failure to lose weight, nausea and vomiting are symptoms of band erosion.
References
- Surgery for Obesity and Related Diseases. Consensus Conference Statement: "Bariatric Surgery for Morbid Obesity"; Henry Buchwald, MD, PhD, FACS; 2005
- UpToDate. "Complications of Bariatric Surgery"; Daniel Jones, MD, Jamie Adair, MD.; 2010
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