Are you aware that there are nearly two dozen distinct risks associated with gastric surgery? Before making your decision, it’s crucial to familiarize yourself with these potential hazards.
While your medical professional will indeed guide you through all the possible risks and complications linked to bariatric surgery, conducting your own preliminary research can bolster your mental readiness for the consultation.
Gastric surgeries have come a long way over the years, becoming considerably safer than they were in previous decades. This evolution should offer you some comfort as you approach the operation. However, it’s important to remember that no procedure is completely devoid of risks, and preparedness can only take you so far.
The risks and complications associated with gastric surgery can be divided into three primary phases:
- Risks related to the surgical procedure itself
- Short-term risks in the post-operative period
- Long-term risks following the operation
In this article, we will delve deeper into each of these phases to better equip you for each stage of your weight-loss journey.
Risks Associated With The Surgical Procedure Itself
As mentioned before, the most common bariatric surgeries are all very safe, so only a few things can go wrong in rare cases. Some of the few risks related to the surgical procedure are:
- Adverse reactions to anesthesia
- Excessive bleeding
- Blood clots
- Lung or breathing problems
Understandably, the risk of death sounds terrifying. Fortunately, the experience has shown that the initial procedure-related mortality rate for all common weight-loss surgeries is only 0.14% or less.
Post-Operative Short-Term Risks
After the gastric surgery is completed, the patient starts with a post-operative treatment and recovery plan. Even if the patient follows all the guidelines, there are a few risks and complications independent of them. These post-operative short-term complications include:
- Leaks – patients who have a body mass index (BMI) greater than > 50 kg/m2, have a dysmetabolic syndrome X, or those undergoing revisional bariatric operations are most at risk for experiencing leaks.
One of the main symptoms and most worrisome signs that should be addressed quickly are tachycardia (an abnormally rapid heart rate, >120 beats per minute (bpm)), fever, dyspnea, and abdominal pain. The symptoms usually emerge within three days after the operation.
- Stenosis – a condition, also known as a stricture, where the stomach pouch and the small intestine may narrow. Stenosis causes patients to report the sensation of stuck food and the urge to regurgitate.
- Bleeding – post-operative bleeding that requires intervention occurs in up to 11% of cases in both the Roux-en-Y gastric bypass and sleeve gastrectomy.
- Venous thromboembolism – one of the leading causes of mortality after gastric procedures. Typically occurs three weeks after the procedure. The most prone to this condition are patients undergoing a revisional operation, those whose BMI is greater than >50 kg/m2, and those whose surgery lasted more than 4 hours.
- Vomiting – food intolerance and vomiting are relatively common early on after gastric surgeries due to the gastrojejunostomy becoming too narrow while it tries to heal. Until the upper join remodels back to normal after around six months, it may be necessary to rewind to a liquid diet and soft foods during that time.
Post-Operative Long-Term Risks
Now, let’s dive a bit deeper into the longer-term risks and complications. Still, it’s essential to keep in mind that they don’t apply to every gastric surgery out there, and some risks and complications are not included in the list because they apply to only one specific procedure. You can read more specifically about every procedure here.
Long-term risks may include:
- Dumping syndrome – certain types of foods (mostly sweet or high-fat foods, especially when eating and drinking at the same time) can rush through the small intestine too fast, drawing fluid with it. This may trigger discomfort, weakness, nausea, dizziness, and diarrhea. Fortunately, only 1 in 10 people experience it.
- Ulcers – approximately 15% of gastric bypass patients experience gastric ulcers. It’s diagnosed by endoscopy, and the treatment lasts for three months.
- Gallstones – a common problem among obese people, mainly because of high cholesterol levels or high fatty deposits. Around 25% of all obese people suffer from gallstones.
- Hernia – this defect, obstruction, or hole in the stomach or groin lining usually develops in up to 4.5% of gastric surgery patients.
- Malnutrition – since most gastric surgeries restrict the food amounts you can eat, some patients may experience malnutrition because their bodies don’t get enough micro- (vitamins, minerals) or macroelements (fat, carbohydrates, protein) anymore.
Due to vitamin and nutrient deficiencies, supplements and vitamins must be taken daily (especially vitamins B12 and D, iron, calcium, and other trace elements).
- Supplements and vitamins must be taken daily for acid reflux – a condition when stomach acids leak into the esophagus, causing an unpleasant burning feeling known as acid reflux or heartburn (typically after gastric sleeve procedure).
- Bowel obstruction – operations in the abdomen area create a possibility for forming scar tissue that may cause a blockage of the intestine. Occurs in about 3% of gastric bypass patients.
- Low blood sugar – also known as hypoglycemia, doesn’t usually begin until more than one year after the surgery. It happens due to metabolic changes that cause excess insulin production.
- Revision surgery – about 10-20% of the patients, opt for second revision surgery. Reasons for this may vary:
- in the case of gastric sleeve, the sleeve created to take the place of the stomach may be simply too big;
- in the case of gastric band procedure, the band may sometimes slip;
- the surgeon’s technique might not suit the patient.
However, typically the gastric surgery failure comes back to the patient. Whether they didn’t strictly follow the diet and exercise guidelines they were assigned to, or the necessary lifestyle changes lasted only for a while.
Gastric surgery carries a variety of risks that can be categorized into three main stages: those associated with the surgical procedure, short-term post-operative risks, and long-term post-operative risks. Potential risks during surgery can include adverse reactions to anesthesia, infection, excessive bleeding, blood clots, lung or breathing problems, and in rare cases, death. Short-term post-operative risks could involve leaks, stenosis, bleeding, venous thromboembolism, and vomiting.
Meanwhile, long-term post-operative complications can range from dumping syndrome, ulcers, gallstones, and hernias to malnutrition, acid reflux, bowel obstruction, low blood sugar, and the possible need for revision surgery. A multitude of factors, such as the specific procedure undertaken and patient adherence to dietary and lifestyle guidelines, can influence these risks.
Remember that while the number of potential complications may seem daunting, most are relatively rare, and advancements in the field continue to improve safety and patient outcomes. Being informed and prepared is a significant part of the journey towards a successful gastric surgery. Contact your medical team to discuss your personal circumstances and establish the most suitable roadmap and weight-loss surgery for you.