Weighing the Risks of Weight Loss Surgery

For someone who is interested in the concept of surgery to manage clinically severe obesity, one important question is: What are the pros and cons surrounding such an operation? There are always risks associated with surgery.

You face about the same risks that you would face during any abdominal surgery. It is the act of undergoing a surgical operation, not the particular operation that is done, that causes most of the risk. Obese people are more apt to be at greater risk during an operation due to co-morbidity (other diseases such as hypertension, diabetes, etc.), brought about from the obesity, that place the obese individual at higher risk when having surgery, than people with an average body weight.

Potential risks

• Pneumonia is an infection in the lungs, and after surgery it can be especially serious, because the infection often comes from the gastrointestinal tract, and it can be very destructive. Precautions to prevent pneumonia can be the clearing out the gastrointestinal tract before surgery by using antibiotics as a prophylactic measure at the time of surgery and by using good anesthesia and respiratory treatment.
• Abscess is a collection of infected fluid and can occur anywhere in the body. After an abdominal operation a pocket of fluid may develop and create an abscess. The treatment of any abscess is to drain away the infected fluid, and kill the bacteria with antibiotics. To prevent abscesses it is important to avoid any collection of fluid or blood in the abdomen, at the time of surgery-this is why you will have a drain that will remain in after the surgery is complete.
• Wound Infection is a type of abscess and is treated by draining it much like an abscess. Clinically severe obese individuals have a very deep layer of fat under the skin and it makes it more difficult to use the general methods that surgeons use for treating infection. Special methods have been developed and are relatively easy to treat although they are an annoyance to the patient.
• Urinary Tract Infection can occur due to urine flow being altered after surgery. Patients also have trouble straining down to urinate. Use of a tube, or catheter, is usually used to drain the bladder after surgery. In a rare case this can lead to infection of the bladder and can be remedied with antibiotics.
• Hemorrhage can occur when blood vessels are cut during surgery. A device called an electrocautery that coagulates the blood. Sometimes, a blood vessel may escape and this can cause a hemorrhage, either inside the abdomen or at the skin level. In some cases a return to the operating room may be needed, but this is a rare event.
• Transfusions can become necessary when blood loss occurs and makes the pulse and blood pressure unstable. Unlike the risks formally associated with blood transfusions, today there are much higher standards and controls, making transfusion a much safer procedure. However, even with the very minimal risks associated with modern transfusion precautions, you have the option to donate your own blood and have it safely stored before surgery.
• Bowel Obstruction can occur after any abdominal operation due to scars called adhesions. Sometimes, this adhesion can become obstructed and nothing can make its way through. In some cases emergency surgery may be necessary to alleviate the obstruction.
• Leakage of Bowel Connections can occur when an incomplete seal occurs between the fastenings of the bowel. When this happens fluids from the GI tract, containing at least some bacteria (the bacteria is normal when contained), leaks out into the abdomen and can causes a serious infection accompanied by swelling, a rapid pulse rate, and in some cases the formation of an abscess. This is always a serious complication and indicates that an immediate operation is required, to seal the leak and drain away the infection. However, if drainage is already present surgery may be avoided. Anastamotic leak almost always causes some increase in hospitalization, and increased discomfort from the drain, and the need for repeated X-rays.
• Obstruction of the Stomach Outlet can occur when the gastric bypass surgery produces the small pouch that it intends to, but during the healing process scars that form to promote healing contract to a more than average degree and food cannot get through. If this should occur it usually can be corrected on an outpatient basis. Laparoscopic surgery appears to cut down on the incidence of obstruction of the stomach.
• Chronic Nutritional Problems can be avoided by taking the proper vitamin and mineral supplements recommended by your doctor, and through healthy eating habits.
• Protein Deficiency can occur because the amounts of protein the post-operative patient can take in has been diminished due to the gastric bypass. If during the first half of every meal the post-operative patient takes in protein, the risk of developing a protein deficiency becomes reduced.
• Vitamin and Mineral Deficiency can occur when the restrictive diet of the post-operative patient is not afford the ability to consume the amounts of vitamin-rich foods that an average adult eats during the course of any given day. Malabsorption is part of the reason why the post-operative patient loses weight. However, to remain healthy we can still eat less and maintain the necessary vitamin intake, by taking the vitamin and mineral supplements that our doctor recommends, for the rest of our lives.

Possible side effects after surgery

• Nausea can occur after gastric restriction if one gets a full feeling and continues to eat and vomiting may occur. Limiting food intake when a feeling of satiety is experienced will handle the problem
• Food Intolerance to various foods that you have enjoyed before surgery can occur. Some of these are listed below:
• Red Meats: Red meats are harder to digest and may cause vomiting.
• Sugar: Refined sugars and candy tend to draw fluid into the intestine. After the gastric surgery a condition called “dumping syndrome” may occur when sugar is taken on an empty stomach. It passes rapidly through the stomach into the intestine and draws a large amount of fluid into the bowel. The result is a condition in which the person experiencing it can break out in a sweat, have dizziness, stomach churning, and a rapid pulse. Most people who have this reaction never intake the offending food again!
• Milk Products: To digest lactose our bodies need and enzyme called lactase. After gastric bypass milk and milk products may not be fully digested. If this repeatedly occurs, lactose-free products can be substituted for food products that contain lactose.

After restrictive surgery the amount of food consumed is greatly reduced. Quantities of roughage are just a fraction of what they could have been prior to surgery. Because roughage is so reduced, so is the presence of bowel activity. Stool softeners can provide relief.

Other side effects

• Transient Hair Loss can occur when the body is experiencing a drastic reduction of calories and subsequent weight loss. The body believes that it is starving. One of the side effects, in some persons, is inactivation of hair follicles, causing hair to fall out. This will resolves when nutrition and weight stabilize.
• Loss of Muscle Mass can occur when the body perceiving that it's starving, stores its fat until any other usable fuel has been burned. Loss of muscle mass is preventable. During active weight loss after surgery exercise vigorously as soon as your doctor gives you the okay.