Indigestion, Acid/Bile reflux: I am aware that acid/ bile reflux can happen after this operation leading to heartburn and regurgitation of fluid or food content. I also understand that this risk is higher in people who have had gastro-oesophageal reflux prior to having the operation. The new join between the stomach tube and the intestine is designed to minimise the chance of bile in the intestine refluxing back into the stomach. I am aware however, if this happens, this can lead to bile gastritis. In the rare instance where bile in the stomach tube refluxes into the oesophagus, it can also lead to injury to the oesophagus. I am aware that there has been concern regarding increased risk of oesophageal cancer in the long term as a result of bile reflux. However, to date there has been no reported cases of oesophageal cancer after this procedure. To manage severe bile reflux, anti-reflux surgery, reversal/revision of the bypass or conversion to Roux-en-Y bypass may be necessary.
Anastomotic ulcer: I know that I may develop an ulcer at the join between the stomach tube and the small bowel. I also understand that smoking ( including passive), heavy alcohol use, H pylori infection and non-steroidal anti-inflammatory medications (Aspirin, Ibuprofen, Voltaren etc.), can lead to an increased chance of ulcer formation. I am also aware that strong acid suppression medication (esomeprazole) is used in the first 6 months after surgery to minimize the ulcer risk. I understand a proportion of ulcers can go on to have further serious complications like perforation and severe bleeding, which are surgical emergencies. I also understand that in rare circumstances, when the ulcer fails to heal with medication, there may be the necessity for the operation to be reversed or revised.
Vitamin and mineral deficiencies: After one anastomosis gastric bypass there is malabsorption of many vitamins and minerals. I understand that I need to take vitamin and mineral supplements for the rest of my life to protect myself from these problems. I also know that I need to have at least yearly blood tests to measure the blood levels of these vitamins and minerals. I have been given detailed written information regarding the nutritional supplements by my bariatric dietitian. Common deficiencies that can occur after a one anastomosis gastric bypass include iron, vitamin D, calcium, B12, thiamine and folate. I know that in some cases the deficiencies can be so severe that they can lead to brain or nerve damage, and the operation may have to be reversed as a result.
Dumping Syndrome: I understand that dumping syndrome can occur in some patients after gastric bypass surgery. Symptoms of dumping syndrome include weakness, sweating, nausea, diarrhoea, palpitations and dizziness soon after a meal. I also understand a heavy load of refined sugars/refined carbohydrates, rapid eating, and drinking while eating, are all factors that may increase the risk of dumping. I also understand if it becomes a disabling problem, it may require reversal of the bypass operation.
Bowel Obstruction: Any abdominal operation can lead to post-operative scarring which may lead to bowel obstruction. I understand the chance of this is minimal with keyhole (laparoscopic) surgery. With changes in the orientation of the small bowel after one anastomosis gastric bypass, bowel obstruction can also rarely happen due to prolapsing of the bowel through tight spaces that are created as a result of the operation.
Hair loss: Many patients develop hair loss for a period after the operation. When this occurs it usually starts about 3 – 4 months after surgery and resolves about 7 – 9 months after the operation. This usually responds to the increased oral intake of protein and vitamins, but it may only recover partially.
Inadequate weight loss: I recognize that the one anastomosis gastric bypass surgery is not by any means a perfect treatment and that one of the risks that I face is a possibility of inadequate weight loss following this surgery. I also recognize that I may lose enough weight in the short term but may also experience late weight regain in the long term (close to 20% chance). I understand that I need to follow the dietitian’s instructions and continue my follow up commitments with the dietitian and the surgeon to minimize the chance of this happening.
Extensive weight loss: I clearly understand that I might suffer malnutrition and lose too much weight. I am well aware that some patients sustain excessive weight loss after weight loss operations. I understand that excessive weight loss may require surgical revision or reversal of the one anastomosis gastric bypass procedure to prevent malnutrition, vitamin and mineral deficiencies, or even death.
I am aware that up to almost 1% of people may lose an excessive amount of weight. As a part of this agreement, I promise and agree to monitor my weight and health carefully and if excessive weight loss occurs, I will submit to early and appropriate treatment.
Mechanical Issues: Narrowing (stricture) of the join between the stomach and the small bowel can occur after this operation, which may require further endoscopic procedures or even surgery. Mechanical issues associated with the stomach tube can develop in the form of segmental dilatation leading to a pouch or some narrowing that may require further surgery. Small bowel hernia or a twist (volvulus) can occur very rarely which can lead to small bowel loss.
Port site hernia (Incisional hernia): Extremely rarely, contents within the abdominal cavity can protrude through the muscle slits at the sites of access ports known as a port site hernia. This can be easily corrected with surgery.
Complications of Pregnancy: I understand that obese pregnant women are at higher risk for an adverse peri-natal outcome. I am also aware that there are well known risks to the patient and the baby after surgery for morbid obesity. Vitamin and mineral deficiencies can put newborn babies of gastric bypass mothers at risk.
NO PREGNANCY SHOULD OCCUR FOR THE FIRST 12 MONTHS AFTER THE OPERATION.
Gastric bypass has been shown to cause multiple types of vitamin and mineral deficiencies including iron, B12, folate, thiamine, vitamin D, calcium, and many others. Many of these deficiencies have been shown to cause birth defects or are suspected that they could cause birth defects.
We also know that many patients who lose weight feel that they are well after surgery and forget to take their vitamins. I understand and take full responsibility to be certain not to miss any of my vitamins and obtain a specialist obstetric consultation if I decide to go ahead with pregnancy following surgery.
Unplanned Pregnancy: Warning to women using oral contraceptive pills. Typical failure rates among pill users can be as high as 12 – 20 % according to some surveys. Other factors that have been shown to increase the risk of pill failure are smoking, diarrhoea, vomiting, drug interaction, systemic illness, psychological stress and menstrual disturbances. Therefore, it is important to recognize that birth control pills may not be an effective method of birth control after one anastomosis gastric bypass. Until those factors have resolved, we have found in many cases that oral hormonal methods of birth control may fail after one anastomosis gastric bypass. Couples need to plan another form of non-oral birth control for at least the first 6 – 12 months after surgery. The Depo-Provera injection has been associated with cases of marked nausea in post one anastomosis gastric bypass patients.
Depression: Depression and anxiety are common medical illnesses and have been found to be particularly common after weight loss operations.
Osteoporosis: There is a growing appreciation that weight loss procedures may be associated with the development of osteoporosis and bone disease. Gastric surgery and weight loss in morbidly obese individuals can cause increased bone resorption and increased bone loss. Treatment and prevention include calcium and vitamin D supplementation, and increased weight bearing activity.
22. Need for further surgery in the future: Weight loss surgery comes with no assurance to be able to achieve or maintain a a certain body weight target. In fact some long term weight regain is almost universal and outright failure with regaining all or even more than what you lost may happen in the long term. Up to 20% of post OAGB patients may end up with significant weight regain and may be in need of further measures for weight control including revisional surgery. In another 5%, long term post OAGB complications like intractable bile reflux / regurgitation, ulcer complications, post prandial hypoglycaemia, dumping or mechanical issues leading to blockages ect. may require further corrective surgery when other measures fail to resolve the issue.