About The Surgery!

Complications

Several complications, although possible with any surgery, are more prevalent in obese patients due frequently to poor heart and lung function. These are:

myocardial infarction (heart attack) or heart failure
pulmonary complications such as respiratory failure requiring ventilator support, pulmonary embolus (blood clot from legs or pelvis going to the lungs), lung collapse (atelectasis) or pneumonia

Complications specific to bariatric surgery include:

bowel leaks that may give rise to abscesses that may need re-operation to repair
wound dehiscence (separation of the wound exposing the bowel)
injury to the spleen
ulcers forming at the attachment of the small bowel to the stomach. If antacids are not effective, the surgery may have to be redone
obstruction of the stomach at the point it joins the small bowel may require dilation
poor absorption of iron, folate, vitamins B12, A, D, E and calcium may be seen if these are not given after surgery
gallstones and decreased liver function may be seen due to poor absorption of bile salts
loose skin from loss of fat under the skin may require plastic surgery to excise the loose skin * excessive weight loss despite vitamin and mineral supplements may require a reversal of the bypass

Post-Operative Care

Immediate post-operative care:

Patients stay in the hospital for 1-3 days for recovery of bowel function
One or more drains may be placed in the abdomen. These are removed as the drainage decreases and the bowel regains function
The incision is closed by absorbable sutures
Some surgeons obtain an x-ray dye swallowing study to see if there is adequate emptying of the stomach pouch prior to starting a diet. Diet is usually started with liquids and slowly advanced to solid food. A dietician may be consulted to advise a patient of the proper diet. It is important to remember that the amount of food that a patient can eat is much more limited.

Long-term care

Patients may experience diarrhea with flatulence due to partially digested food for a few months
Patients may need to increase the number of meals a day due to the small size of each meal. Patients notice a quick loss of weight over the first six months, followed by a slower loss of weight over the next 12 to 18 months. By about two years the weight stabilizes
Many patients notice that associated illnesses improve after a few months with the weight loss.
It is important to check for anemia (low blood iron) and deficiency of vitamins and minerals, which can occur from the surgery. Multivitamins and iron supplements are needed to make up for their poor absorption.
Follow-up visits may include blood tests for sugar and cholesterol, which usually fall after surgery.
There may be excessive loose skin hanging from the abdomen due to loss of fat under the skin. This may require plastic surgery (tummy tuck) to trim away the excess skin.

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Copyright ©2007 Bradley J. Amson, FRCSC

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