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Risks of weight-loss surgery

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23/12/2006

Lung Problems

  • Atelectasis
    Atelectasis or partial collapse of the lungs is very common after surgery.  It is particulalry common in obese patients when the bottom portion of the lungs are "squashed" and open only with coughing and very deep breaths.  This can lead to pyrexia, pneumonia and shortness of breath.
  • Pulmonary Embolism
    A pulmonary embolism is a blood clot in the lungs.  The problem actually begins in the legs where blood clots form in the veins of the calves or thighs.  These can cause leg swelling and/or pain.  They can break off and travel to the lungs.  A large clot can cause shortness of breath or completely block blood from entering the lungs and cause death.  Overweight patients have a higher risk of forming blood clots in the legs, particularly during or soon after surgery.

    To prevent pulmonary emboli, during and after surgery your legs will be fitted with sequential compression boots which act like blood pressure cuffs and massage your legs and prevent blood clots from forming.  A small dose of the blood thinner heparin is given at the time of surgery. The best prevention is to get out of bed and walk soon after surgery.  We will ask you to continue to administer this yourself at home for the first week.
  • Leakage of Bowel Contents

Leakage of bowel contents from the new connection between the stomach and the small intestine or between two parts of intestine is the most serious complication of gastric bypass and biliopancreatic diversion.  Such leaks can cause a high heart rate, pain in the abdomen or back, fever, infection and even death. Treatment usually entails antibiotic therapy or surgical repair and depends on the size of the leak.

  • Blockage of the Stomach Remnant

    In the Roux-en-Y gastric bypass, a new stomach pouch is made from top of the stomach and the rest of the organ is detached and left alone.  The stomach remnant remains alive but it shrinks in size.  In rare instances, a blockage can develop in the stomach remnant and cause back-up of fluid and leakage of bowel contents.  This condition can be difficult to diagnose because it does not cause vomiting.  However, it may cause persistent hiccups or left shoulder pain.

  • Narrowing of the Stomach Pouch Outlet

In gastric bypass surgery the connection between the new stomach pouch and the intestine is created with a stapling technique. With all healing, there is scar formation similar to a scab.  Sometimes, this scar can tighten around the connection and cause it to narrow to a point where food cannot pass through.  This problem typically occurs four to six weeks after surgery.  It can be treated by stretching the narrowed opening, which is done endoscopically by a gastroenterologist.

In Lap-Band patients, the opening between the upper and lower stomach pouches can also become too narrow.  This can be corrected with a simple band adjustment.

  • Wound Infection

    As with any surgery, the incision site can become infected.  In overweight patients with more fat in the abdominal walls the infection can be deeper than usual.  Minor infections are treated with oral antibiotics.  Deeper, more serious infections may require opening the wound and packing.

  • Band Slippage

    In Lap-Band surgery, a band is placed at the top of the stomach and held in place by sewing the stomach around it.  In rare instances, the band can slip and cause constant regurgitation and heartburn.  Symptoms are relieved by loosening the band.  The diagnosis is confirmed with a barium-swallow study.  If this happens, the band would likely need to be repositioned with another operation, laparoscopically.  A special diet of liquids, shakes, and purees, followed for the first month after surgery, helps prevent this condition.

  • Band Erosion

    On rare occasions after Lap-Band surgery, the band erodes into the stomach. This does not cause pain, but may result in inadequate weight loss.  This is diagnosed by endoscopy and repaired with further laparoscopic surgery.


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SPIRE Hospital, Bristol. 
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Contact: Claire Trenberth - 0117 9804051
claire.TRENBERTH@spirehealthcare.com
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