Complications of Bariatric Surgery

There are risks with any surgery

Bariatric operations are major surgery involving division and joining of stomach and intestine. The human body is wired in a way that injury to an internal organ is not readily felt The most of the pain associated with abdominal operations come from the cut in the body wall used to gain access to the internal organs. Laparoscopic surgery removes the pain of a large body wall cut and make patients recover faster giving them the impression of having had a not a serious operation and a sense of safety.

Fortunately the chance of serious complications after bariatric surgery is very rare.

You should go into any surgery confidently. Speak with your doctor about the known potential risks and complications of weight loss surgery of your choice, as well as any surgical alternatives that are worth considering. So you can make the most-informed choice for yourself.

First month

You are going to be in the hospital for up to three days after surgery. Most of the acute complications can happen during the first four weeks. If there is a concern from your side as to the possibility of an acute complication, you should make timely contact with your surgeon.

If the situation demands urgent and prompt action please contact Dr. Werapitiya on his mobile 0438 967 237.

Bleeding

Surgery involves incisions and cutting that can result in bleeding which can vary from minor to massive bleeding. Bleeding if excessive may require blood transfusion or emergency surgery and may even lead to death in extremely rare circumstances. Bleeding is most serious if it is within the abdominal cavity and the bleeding can also occur into the intestine from the bowel joint.

For patients on blood thinners and or blood pressure medication – blood thinners can lead to higher chance of bleeding after surgery and hence the need for stopping such medication prior to surgery under medical supervision. Uncontrolled high blood pressure is another factor that increase risk of bleeding hence the importance of taking blood pressure medication on the day of surgery as usual.

Leak

Stapling and stitching is involved with bariatric surgery creating a stomach tube and new connections between gut components. These staple and suture lines are meant to be water tight without any leakage of intestinal content to the abdominal cavity. There is a rare risk of leaking (1 – 2%), particularly in the first two weeks after the surgery. Leaking from the staple line/bowel join is a serious problem. The leak will allow stomach acid, bacteria, bile, digestive enzymes to escape into the abdominal cavity causing severe infection (peritonitis) that may even be potentially lethal.

If a leak is suspected, you may have to undergo further tests including x-rays and emergency surgery. Initial steps in emergency surgery are aimed at controlling infection and inflammatory reaction by cleaning the leaked content by abdominal cavity washout diverting further leakage by placement of multiple drain tubes. Complete resolution of a leak can take a long period of time, usually requiring you to have in hospital care for a long period of time, sometimes weeks or even months. In the process, you may also require intensive care treatment or transfer to a different hospital for optimal care.

Leak after a sleeve is almost always at the upper end of the staple line. Sleeve tube has high pressure build up within compared to the stomach tube of a gastric bypass, which explains as to why a sleeve leak is generally more difficult to treat.

Blood Clot

Also called deep vein thrombosis (DVT) and pulmonary embolus (PE). Although this is an exceedingly rare complication, but it can even lead to death. PE is still the most common cause of mortality after bariatric surgery and most occur 3 weeks after the procedure. Blood thinning medications will be administered while you are in hospital to minimise the risk of blood clotting and calf compression stocking’s will be used to prevent blood pooling in leg veins. From your part, it is important that you get out of bed as early as possible and move your feet and legs to try and help prevent blood clots. It is also very important keeping up with your fluids to prevent dehydration.

Long term complications

Reflux (GORD)

There is a valve or sphincter mechanism built into the lower end of the oesophagus to prevent stomach content flowing back. When the valve mechanism is not working properly the result is the reflux. After bariatric surgery reflux can be a troublesome problem in the long term and it may be difficult to treat.

Acid Reflux

Stomach lining secrets strong hydrochloric acid which can burn and injure the oesophagus when exposed. It is now known that acid reflux can be a common long term problem after sleeve gastrectomy. Small stomach tube after sleeve gastrectomy has a high pressure within that overcomes the resistance of lower oesophageal valve which leads to higher chance of reflux. Acid reflux usually manifest with heartburn and is treated with strong medications that suppresses the acid production. After sleeve gastrectomy it is more common to develop a hiatus hernia and distension of the thin walled top end of the stomach tube. These factors together increase the chance of fluid reflux commonly leading to throat and chest symptoms due to aspiration. It is now recognized that bile reflux can also be a common occurrence after sleeve gastrectomy which explains why there is sometimes poor response to anti acid medication.

Long term reflux can also lead to a changes on the surface of the lower oesophagus called Barrett’s change. This is a precancerous condition. There is some concern of chronic reflux increasing the chance of Barrett’s and hence very rare possibility of oesophageal cancer after sleeve gastrectomy.

It is observed that reflux after SADI-S operation is not as common compared to sleeve. Both OAGB and Roux-en-Y gastric bypass have a lower pressure within the newly created stomach tube and have very low risk of acid reflux. While sleeve is expected to make the preexisting reflux symptoms worse gastric bypass operation will generally make the reflux better.

Bile Reflux

Bile reflux is a well recognized rare problem after OAGB. Due to loop configuration bile can enter the stomach tube that can reflux into the oesophagus. It is expected around 1% of people with OAGB may end up having further surgery due to bile reflux.

With the introduction of OAGB, a major concern amongst the opponents was the possibility of bile reflux leading to an increased chance of oesophageal cancer in the long term. Over the last 20 years no case of oesophageal cancer been reported after OAGB. However it still remains a theoretical possibility.

Hiatus Hernia

Fixing the hiatus hernia if there is one and great deal of technical precision at the sleeve operation are important factors to prevent reflux.

Nutritional deficiency

There is a great reduction in the food consumption after bariatric surgery which exposes to the risk of vitamin and mineral deficiencies. With intestinal bypass procedures there is an additional risk of malabsorption which increases this risk even further. To prevent this it is important that you comply with your bariatric dietitian’s recommended daily nutritional supplementation regimen. You are also required to monitor nutritional health with annual blood tests. Most commonly observed deficiencies are Iron and Vitamin D.

Marginal ulcerations

This is a unique complication associated with up to 5% of gastric bypass surgeries. Smoking, non-steroidal anti- inflammatory medications (Aspirin, Ibuprofen, Voltaren etc.) heavy alcohol use and H pylori infection are risk factors for ulcer formation. proportion of ulcers can go onto have further serious complications like perforation and severe bleeding which are surgical emergencies.

Mechanical issues

With sleeve gastrectomy, stomach tube dilatation at the top end with resultant pouch migration into the chest in the for of a hiatus hernia can occur. This commonly leads to reflux and regurgitation symptoms. Mid stomach tube narrowing, kink or a twist can lead to after meal obstructive symptoms. With gastric bypass narrowing of the connections between stomach tube and small bowel can lead to obstructive symptoms. Internal herniation of small bowel is a problem after Roux-en-Y gastric bypass.

Dumping syndrome

Dumping syndrome is caused by rapid emptying of stomach with dumping of its content into the small bowel. symptoms of dumping syndrome include abdominal pain, weakness, sweating, nausea, diarrhoea, palpitation and dizziness soon after a meal especially high in sugar. This occurs commonly after gastric bypass surgery.

Gallstones disease

Gallstones are more common after significant and rapid weight loss like after bariatric surgery. Gastric band related complications are not discussed here as this is not an option we offer.

Gastric band related complications are not discussed here as this is not an option we offer.

A more comprehensive and a detailed list of complications will be provided to you once
after you have selected a procedure.

Complications of Bariatric Surgery

There are risks with any surgery

First month

Bleeding

Leak

Blood Clot

Long term complications

Reflux (GORD)

Acid Reflux

Bile Reflux

Hiatus Hernia

Nutritional deficiency

Marginal ulcerations

Mechanical issues

Dumping syndrome

Gallstones disease

Would weight loss surgery benefit you?

40kg

88kg

24kg

Your Expected weight loss in 1 year

3.5kg

3.2 - 6.7kg

22 - 37kg

Your Expected weight loss in 1 year

8.8 - 13.2kg

1.3kg

1.2 - 2.4kg

No recommendation based on your BMI.

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