Bariatric surgery is intended for people who are 100 pounds or more overweight (with a Body Mass Index (BMI) of 40 or greater) and who have not had success with other, less risky weight loss therapies such as diet, exercise, and medications. In some cases, a person with a BMI of 35 or greater and one or more co-morbid condition may be considered for bariatric surgery.
Bariatric surgery should not be considered until you, and your doctor has explored all other options. The best approach to bariatric surgery calls for a discussion of the following:
- Bariatric surgery is not cosmetic surgery.
- Bariatric surgery does not involve the removal of adipose tissue (fat) by suction or surgical removal.
- Together, you and your doctor should discuss the benefits and risks.
- You must commit to long-term lifestyle changes, including diet and exercise, which are the key to the success of bariatric surgery.
- Complications after surgery may require further operations.
- Patients who underwent bariatric surgery have significantly reduced rates of developing cancer, cardiovascular diseases, endocrinological disorders, infectious diseases, musculoskeletal disorders, psychiatric disorders, and pulmonary disorders.
Surgical Risks for Gastric Bypass and Gastric Banding
As with any surgery, there may be immediate and long-term complications and risks. Discuss the benefits and risks with your healthcare team.
Possible risks associated with abdominal surgery can include, but are not limited to:
- Shoulder pain
- Complications due to anesthesia and medications
- Deep vein thrombosis (clotting in the veins, commonly in the lower extremities or pelvis)
- Carbon dioxide embolism
- Injury to the stomach, esophagus, or surrounding organs
- Dehiscence (separation of areas that are stitched or stapled together)
- Leaks from staple lines
- Marginal ulcers
- Pulmonary problems, pulmonary embolism
- Spleen injury (to control operative bleeding, removal of the spleen may be necessary)
- Stroke or heart attack
- Stenosis (narrowing of passage, such as a valve)
Potential Risks and Complications After Gastric Banding
- Migration of implant, which includes band erosion, band slippage, and port displacement
- Tubing-related complications, which include port disconnection and tube kinking
- Abdominal hernia
- Band leak
- Chest pain
- Collapsed lung
- Enlarged heart
- Esophageal spasm
- Gastrointestinal injury
- Gastrointestinal swelling
- GERD (gastroesophageal reflux disease)
- Inflammation of the esophagus
- Inflammation of the gallbladder
- Inflammation of the stomach
- Kidney tubular necrosis
- Pain caused by passing a gallstone
- Port site infection
- Pulmonary embolism
- Stoma obstruction
- Stretching of the stomach
- Surgical procedure repeated
- Back pain
- Difficulty swallowing
- General abdominal pain
- Hair loss
- Inflammation of the nasal passages
- Inflammation of the sinuses
- Joint pain
- Pain after surgery
- Port site pain
- Upper abdominal pain
- Upset stomach
- Upper respiratory tract infection
- Urinary tract infection
- Selective food intolerance
- Reflux esophagitis
- Gas bloat
- Esophageal dysmotility
- Weight regain
- Fluid leakage from the balloon or tubing
- Esophageal dilation
- Gastric prolapse
According to the American Society for Metabolic and Bariatric Surgery 2004 Consensus Statement, the operative morbidity (complications) associated with Roux-en-Y gastric bypass in the hands of a skilled surgeon is approximately 5%, and the operative mortality (death) is approximately 0.5%.
For gastric banding, the same consensus statement reported that, in the hands of a skilled surgeon, the operative morbidity is approximately 5%, and operative mortality is approximately 0.1%.
Why Would I Have an Open Procedure?
In some patients, the laparoscopic or minimally invasive approach to surgery cannot be used.
Here are reasons why you may have an open procedure, or that may lead your surgeon to switch during the procedure from laparoscopic to open:
- Prior abdominal surgery that has caused dense scar tissue
- Inability to see organs
- Bleeding problems during the operation
Based on patient safety, the decision to perform the open procedure is a judgment made by your surgeon either before or during the actual operation.