Severe or chronic obesity is difficult to treat with diet and exercise alone, even when accompanied by a professional medical team. Due to the health and economic burden of obesity and the series of diseases associated with it, bariatric surgery is becoming a widely accepted option, during which patients undergo an operation involving their stomach or intestines to help them lose weight.
Bariatric surgery restricts food intake or interrupts the food digestion to enhance weight loss and decrease the development of diseases like diabetes or heart conditions. It is particularly designed for patients with a Body Mass Index (BMI) higher than 40 or higher than 35 and who suffer from an associated health problem, such as type 2 diabetes, heart disease or sleep apnea.
There are currently three main types of bariatric surgery, which are gastric bypass, sleeve gastrectomy and gastric banding. Since they all offer both benefits and risks, the choice on which procedure to choose must be carefully considered along with a physician. Below are some of the well established bariatric surgery complications and risks associated with the procedures.
Bariatric Surgery Complications: Gastric Bypass
Surgeons use staples or a plastic band during a gastric bypass surgery to create a small pouch in the stomach, as well as attach a part of the small intestine to the pouch. The first part of the procedure reduces the amount of food intake, while the second one enables the food to bypass the rest of the stomach to decrease the absorption of calories and nutrients.
The main bariatric surgery complications for patients who undergo a gastric bypass include excessive bleeding, infection, adverse reactions to anesthesia, blood clots, lung or breathing problems or leaks in the gastrointestinal system. To address these possible complications, patients may need to be submitted to additional surgeries to correct the problem.
In addition, there are other long-term risks and complications associated with the weight-loss surgery that are rare but possible. These include bowel obstruction, dumping syndrome that causes diarrhea, nausea or vomiting, gallstones, hernias, low blood sugar (hypoglycemia), malnutrition, stomach perforation, ulcers, or vomiting and even death.
Bariatric Surgery Complications: Sleeve Gastrectomy
During a sleeve gastrectomy procedure, about 90% of the stomach is surgically removed using a laparoscopic technique, decreasing the patient’s capacity to eat. The stomach’s capacity is reduced to between 100 to 200 ml and it aims to address the problem of an expanded stomach due to large amounts of food or liquid intake — a common issue for people with obesity. The large size of the stomach enables patients to eat much more than what they need to maintain a healthy weight.
This procedure is the most invasive one, since it does not reduce the stomach’s capacity, but it removes a large part of the organ permanently. Therefore, the complications associated with the procedure are rare but often more severe than the ones associated with other methods. Severe complications include postoperative bleeding, leaks at the staple line, infection, wound issues, intolerance to some foods, organ damage, blood clots, pneumonia or chest infection.
Long-term complications include adhesions (scar tissue) in the gut, subsequent hernia formation related to the wound closure, gastro-oesophageal reflux, and malabsorption of micronutrients. Despite the fact that all of these are rare side effects from the surgery, it may require patients to undergo further procedures.
Bariatric Surgery Complications: Gastric Banding
The surgical procedure of gastric banding consists of stomach reduction to improve weight loss. During gastric banding, surgeons place a silicone band around the upper portion of the stomach, creating a small pouch and decreasing its size and capacity. Therefore, patients feel full faster and with smaller amounts of food. In addition to the gastric band, the treatment requires commitment to lifestyle alterations and follow-up consults with a physician.
The gastric band is a long-term implant, but it is not a permanent device and many patients undergo additional simple procedures to reposition, replace or remove it. There are currently two gastric banding devices approved by the U.S. Food and Drug Administration (FDA), the Lap-Band Gastric Banding System and the Realize Gastric Band.
Despite being the least invasive and risky procedure, there are some complications that need to be taken into consideration. These are nausea, vomiting or spitting-up food, difficulty swallowing, gastroesophageal reflux disease (GERD), indigestion or upset stomach, abdominal pain, leaking of the gastric band, stretching of the stomach pouch, moving of the gastric band from the original placement, erosion of the band through the stomach wall or into the stomach, and stretching of the esophagus.