Chapter 3

Risks of Bariatric Surgery

You’ve read the basics of bariatric surgery and its most common types in the two previous chapters. However, it is not the right time to pick your surgical therapy of choice. We’ve written this chapter with informational purposes to give you vital knowledge to be able to make this critical decision.

Just like other surgical procedures, bariatric surgery has its own risks. Yes, it helps you lose weight, improves your self-esteem, reduces the actual rate of death by eliminating serious complications caused by morbid obesity. In other words, bariatric surgery changes your life forever. But in order to solve a problem, you don’t want to make another one. So, it is significant for bariatric surgery candidates to be totally aware of all the aspects of weight loss surgery process and each and every state their bodies will go through before, during, and after the surgical procedure.

What you should know is:

-The early complications, which are possible occur within a short time after bariatric surgery procedure.

– The acute and long-term risk percentages that might affect your life months or years after the surgical weight-loss procedures.

– The surgical risks during the process.

– The postoperative complications after each type of surgery.

– Psychological and emotional consequences after surgical treatment of morbid obesity.

– And finally, if there is anything you can do to decrease complication rates.

Ready to go into these topics?

Well, let’s begin.

Why Bariatric Surgery Has Some Health Risks?

Bariatric surgery is usually followed by some complications simply because of two reasons:

1- First of all, after surgical treatment, either the amount of your food intake declines or your body absorbs fewer nutrients. As a result, you might face mineral and vitamin deficiencies and the other challenges followed by it.

2- The second reason is that all types of surgery have certain complication rates and bariatric surgery is not an exception.

The Most Common Early Complications of Bariatric Surgery

The truth is that weight loss surgery is not among the high-risk surgeries that are currently performed. According to North Bristol NHS Trust, about 1% of bariatric patients deal with a problem after gastric band surgery. However, everything changes from patient to patient according to their health history and mental circumstances.

Because sleeve gastrectomy and gastric bypass are more complicated procedures, the complication risk is about 3%. Also, this number has become lower over time since a lot of research has been done in this field to make bariatric abdominal operations safer and it will continue to decrease in the future as well.

Here’s a list of the most common post-surgical risks that may threaten your health right away or just a few days after surgery:

1- Leakage

  • Anastomotic leak is one of the most common complications that will mostly occur till 3 days after the gastrointestinal surgery.
  • Bariatric procedures surgeons should watch patients after the surgery and check their heartbeat from time to time. Rapid heart rate, over 120 bpm, fever, and any abdominal pain are worrisome signs of leaks.
  • If diagnosed early and treated in the very beginning, there is almost nothing to worry about.

2- Bleeding

  • Unfortunately, bleeding is one of the most common postoperative complications and is seen in up to 11% of gastric sleeve and gastric bypass procedures.
  • But fortunately, in 85% of these cases, it is possible to stop the bleeding without surgical operations.
  • There are numerous non-operative methods that will help surgeons control and manage bleeding, hemodynamic monitoring, serial hematocrit, and blood product transfusions, to name a few.
  • If your surgeon fails to manage bleeding through non-surgical ways, you’ll need emergency surgical management.

3- Bowel Obstruction

  • Small bowel obstruction or SBO mostly occurs after gastric bypass surgery.
  • It mostly occurs because of an internal hernia.
  • Its possibility varies from 0 to 5%.

4- Pulmonary Artery Embolism

  • Pulmonary embolism or PE is one of the most common complications, especially after gastric bypass.
  • Increased age and higher body mass index (BMI) escalate its possibility.
  • The risk of this complication exists until weeks after the surgery. So, PE prophylaxis – a treatment plan for preventing pulmonary embolism – is necessary during this period.

Here’s a demonstration of the chances of each of these early complications.

Bariatric Surgery Early Complications

The Most Common Late Complications of Bariatric Surgery

Any complications that occur after 30 days of your surgery are considered in the long-term or late ones.

1- Dumping Syndrome

Dumping syndrome is one of the most common drawbacks of weight loss surgery. It is caused because consumed food does not undergo complete digestion and is dumped into the large intestine.

2- Internal Hernia

– There is a higher chance of incisional hernias after open gastric bypass, about 20%.

– The majority of cases with internal hernias happened between 6 and 24 months after the operation.

3- Low Blood Sugar

– Hypoglycemia is a condition when excess insulin is produced in patients’ bodies, which leads to a quick reduction of glucose.

– It occurs because due to the metabolic changes caused by stomach surgery.
– During your follow-up sessions, ask your doctor for blood sugar control.

4- Malnutrition

It is a part of your surgeon’s responsibility to warn you about the possibility of malnutrition after surgery. This issue occurs mainly because of some changes in absorption of vitamins and absorption of calories overall. It is observed in two types:

– Protein-energy malnutrition

– Lack of micronutrients such as iron, vitamin B, Vitamin A, folate, and etc.

5- Ulcer

– Ulcers may occur within weeks or years after the surgery.

– They usually cause pain, bleeding, or a hole in your stomach.
– Smoking is one of the main causes of ulcers after weight-loss operation.
– It can be treated using specific medications prescribed by your doctor.

6- Acid Reflux

– Acid reflux usually occurs after gastric sleeve surgery or any other type of restrictive surgery when the size of the stomach is decreased.

– The reduction of the stomach causes pressure in the stomach, which leads to weakening in the lower esophageal sphincter.

Acid Reflux AFter Gastric Bypass

Severe Obesity Surgery Risks by Types

Some obesity surgery complications are common between all or most types, but some other are specific to just one of them. If you’ve read the previous chapter on the types of surgery, here’s an opportunity to complete your information by comparing their risks in more detail.

Gastric Bypass Gastric Sleeve Adjustable Gastric Banding Biliopancreatic Diversion with Duodenal Switch
Bleeding
Abscesses
Leakage (Anastomotic leaks, stomach leak, leakage at the bypass connections) (staple line leakage) (port leakage) (Anastomotic leaks)
Dumping syndrome
Metabolic bone disease
Gastroesophageal reflux disease
Nutritional deficiency
Band slippage
Band erosion
Abdominal bloating  
Diarrhea  
Gallstones  
Intestinal irritation and ulcers  

Psychological Effects of Bariatric Surgery

Weight loss stomach surgery involves noticeable lifestyle changes, which result in significant psychological impacts on obese patients. Some of these changes are positive, yet some other are annoying.

The streamlined management of obesity after the operation makes life more enjoyable. A notable boost in your confidence and self-esteem is the major psychological outcome of durable weight loss and reaching your ideal body weight. However, adjusting to the post-operative life is not easy for all patients. As a consequence, they might experience depression, anxiety, or mood swings.

Another reason that strengthens patient’s inability in getting along with their new life is the lack of support from their friends and family members.

The more you change your mindset and prepare yourself before the surgery, the less are the chances of emotional difficulties after the procedure.

In addition to that, it is vital that you make your beloved ones aware of your situation and educate them to truly understand what your body is going through.

After that, reaching your ideal weight will be so much easier!

How to Reduce the Risks of Bariatric Surgery

1- Educate yourself.

2- Inform your family and friends of your situation.

3- Do a lot of research before choosing your surgeon.

4- Lose some weight before surgery.

5- Inform your doctor of all your medical history.

6- Start doing exercise as soon as possible.

1- Educate Yourself

Do thorough research about:

  • Whether you’re a good candidate for any type of weight loss surgery.
  • Which type is better for your condition.
  • The risks after each weight loss abdominal surgery.
  • What changes you should make in your life both before and after the surgery.
  • Which weight-related comorbidity is caused by each type.

2- Inform Your Family and Friends

  • You need their support, so, they should tell them exactly the changes you’re going through.
  • Long-term weight loss, both before and after the surgery can be really difficult if they do not help you.
  • After the surgery, you cannot eat anything you want. So, they should be careful what they eat when you’re present in order not to tempt you to eat any unhealthy food.
  • An increase in suicide risk has been observed in some cases. Therefore, it is vital for you to have the emotional support of your family and friends, at least till you get used to your new lifestyle.

3- Do a Lot of Research Before Choosing Your Surgeon

  • Your surgeon’s expertise not only affects the success of your surgery but also to what extent you experience postoperative complications.
  • In case of any issue after the surgery, your surgeon’s attention and proficiency are effective in how they manage your complications.

4- Lose Some Weight Before Laparoscopic Surgery

  • One of the factors that influence the safety of your surgery is your BMI, which is exactly why some surgeons help their patients experience some excess body fat loss before the surgery.

5- Inform Your Doctor of Your Medical History

  • Obstructive sleep apnea and gastroesophageal reflux disease are the two main medical conditions that increase the risk of operation. Your doctor must be aware of them so that they will be more sensitive to these issues.
  • There are three major risks that if you experience before the surgery, it is possible that you experience them again after the surgery:

– Deep vein blood clots

– Blood clotting difficulties

– Pulmonary embolism

  • Also, cooperate during your psychological assessment and let your psychologist become totally aware of your mental state.

6- Start Doing Exercise as Soon as Possible

  • The sooner you restart physical activity, the faster your healthy weight loss process will be and of course, you will have to deal with fewer complications and no inadequate weight loss.
  • Regular exercise eliminates your anxiety and regulates your hormones. So, the risk of psychological complications is less when you are active.
  • Try to move as soon as you can and you’ll be able to get back to your daily activities soon.
  • Staying active also prevents any future weight regain.

With all These Risks, Why Should I Consider Bariatric Surgery?

The answer is simple: the risks of morbid obesity are much greater than the risks of weight loss surgery.

1. In 97% of cases, quality of life improvements will occur.

2. You will be at a lower risk of heart disease.

3.  High blood pressure normalizes up to 60%.

4. Sleep apnea has been resolved in 85% of cases.

5. High or complete remission of type 2 diabetes will be achieved.

6. Depression is cured in 55% of patients.

7. Blood Cholesterol decreases after 60% of surgery cases.

8. Fatty liver is improved in 90% of cases.

9. Increased fertility in both men and women.

10. Resolution of PCOS in women.

11. The alleviation of joint and back problems.

12. Overall reduction in mortality rates caused by obesity.

and so on…

So, the question is, why not bariatric surgery?

If you think changing your lifestyle picking up new eating habits before and after weight loss surgery is difficult, you must definitely take a look at the next chapter where we provide you with tips on picking up new eating habits before and after weight loss surgery.

Have you decided the type of your surgery? If you haven’t decided yet, maybe you should review the previous chapter on types of surgery.