Post-op: When to Call the Doctor

December 11, 2013

and Other Post-Op Concerns

For those who have chosen weight loss surgery, it's important to remember that inherent in all surgery are risks as well as benefits.  And while statistics show that the benefits of weight loss surgery greatly outweigh those risks, post-op problems, including the occasional buyer's remorse, may arise for some patients. Your surgeon has assessed your risk-benefit ratio before taking you to the OR, but here are a few patient questions that frequently come up after the fact.

What could go wrong after a bypass or sleeve that would send you to the ER?

Usually after these operations, you're feeling a little bit better every day, so severe pain could indicate that the surgical connections may be breaking down and leaking.  When you get leaking of those digestive contents into that sterile space, you get infections starting. And the body's responses to infections are usually a fast heart rate, sweating, fever, pain, not being able to get a deep breath. These things are usually accentuated compared to days before or immediately after surgery, so that would be a reason to come in. Any sudden-onset shortness of breath or increased pain levels are signs that at least your doctor should get a call. After recovery, the most serious thing that would bring a bypass patient to the ER would be twisting of the intestines, causing a bowel obstruction, or bleeding from an ulcer. Of course, if you don't chew your food well and swallow something too big, you may get food stuck in your new plumbing and have some temporary pain or discomfort. You may even need a procedure to fish it out!

There's a lot of talk about revisions and the need for subsequent surgeries. Why do people have a second surgery, and which way do they usually go?

There is always the possibility of revision in bariatric surgery. Bypasses can break, sleeves can break, bands can break. There are those who will be unhappy with their weight loss, and will choose to convert to what's considered a more extreme operation. After a failed band, most patients choose the bypass or sleeve gastrectomy. Some people are actually adding a band on top of a bypass, since we very seldom undo a bypass. Others are looking to add some of the weight loss drugs that are largely ineffective when used alone to increase their weight loss. The problem is that most of the drugs don't lend themselves to long-term use, so while they can jump start you and re-motivate you, they can't be taken forever. So the short answer to your question (yes, I know it's too late) is that bands are only revised to bands if the patient has achieved good weight loss initially and then for some reason, like the band slips or the pouch dilates, it failed. Otherwise, bypass or the sleeve are the most common options.

Can you reverse these operations or are patients stuck with their decisions forever?

We can actually reverse a bypass, but in general, we won't. The biggest reason we would have one reversed is if the patient had symptoms of dumping that just wouldn't go away. There are some medications that might help, but let's say that every time you tried to eat anything that had any sort of fat or any sugar in it, you experienced severe symptoms of dumping, you'd say it's not worth it. If you're passing out, if you wouldn't be able to hold a job, if driving has become dangerous, those would be reasons to consider reversing the bypass. If someone had ulcers that would never heal, then sometimes reestablishing the anatomy might be an option. Really severe complications from the operation, not just weight gain, might convince us, but if a patient says I just don't want to eat this way, I don't want to have to remember to chew my food, we won't reverse for that. Of course, sleeve gastrectomy patients have a large portion of their stomachs removed, so we can't reverse a sleeve.

Excerpted from WEIGHTY ISSUES: Getting the Skinny on Weight Loss Surgery, by Scott A. Cunneen, MD, FACS and Nancy Sayles Kaneshiro, © 2013. All rights reserved.



Dr. Scott Cunneen, Director of Bariatric Surgery Cedars-Sinai Medical Center, Los Angeles. Author of WEIGHTY ISSUES: Getting the Skinny on Weight Loss Surgery. He holds a bachelor’s degree from the University of Notre Dame, a master’s degree in physiology from Georgetown University and a master’s degree in human nutrition from Columbia University College of Physicians and Surgeons.

Read more articles by Dr. Cunneen!