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Dr. Doru I.E Georgescu
Dr. Doru I.E Georgescu
Dr. Doru I.E Georgescu
Obesity Surgery

Laparoscopic Gastric Bypass

Gastric Bypass :: Procedure Guide :: Risks and Complications :: Post Operative Instructions

Risks and Complications

Risks, complications and adverse events you need to know about:

All surgical procedures have risks. When you decide on a procedure, you should know what the risks are. Talk with your surgeon in detail about all the risks and complications that might arise. Then you will have the information you need to make a decision.

What are the risks?

Any surgical procedure, laparoscopic or open, requires the acceptance of some risk in order to gain the benefits sought from the operation. There are many risks associated with this surgery including those associated with obesity, history of embolism, diabetes, high blood pressure, heart disease, lung disease or prior abdominal surgery, especially prior surgery on the stomach. The more common risks include: infection, bleeding, nerve injury, blood clots, heart attack, allergic reactions, and pneumonia. These risks can be serious and possibly fatal. The administration of anesthesia also involves risks, most importantly the rare risk of reaction to medications causing death.

Specific risks of Gastric Bypass Surgery

  • spleen or liver damage (sometimes requiring spleen removal)
  • damage to major blood vessels
  • blood clots in legs or lungs
  • stomach or intestinal leak
  • stomach or intestinal stricture

Note: Laparoscopic surgery is not always possible. The surgeon may need to switch to an "open" method due to some of the reasons mentioned here.

What are the possible complications?

Patients can experience complications after surgery. Most complications are not serious but some may require hospitalization and/or re-operation. Some of these complications may include:

  • Significant bleeding/Need for transfusion
  • Stomach and/or Intestinal Leak
  • Ulcer and/or Outlet Obstruction
  • Stomach and/or Intestinal Stricture
  • Stomach, Spleen and/or other Organ Injury
  • Hematemesis (vomiting of blood)
  • Infection/Abscess Formation
  • Dehydration
  • Internal Hernia and/or Bowel Obstruction
  • Vitamin & Mineral Deficiencies
  • Acute Stomach Remnant Dilatation
  • Wound Problems (Infection, Hernia)
  • Gallbladder Problems
  • Weight Regain
  • Nausea, Vomiting and/or Gas Bloating
  • Dumping Syndrome
  • Blood Clots in the Veins (DVT)
  • Pulmonary Embolism
  • Respiratory Failure

Long Term Complications

Long term complications with bariatric surgeries have been low.

  • The most frequent late complication is weight gain due to enlargement of the pouch, enlargement of the outlet, and last, but not least, patient non-compliance.
  • The development of gallstones is related to the rapid and significant amount of weight loss and therefore is highest in the first six months after surgery. Gallstones are not a complication of surgery as such, but rather a complication of rapid weight loss. Obese persons have a very high rate of gallstone formation compared to normal weight persons, mainly because of the many diet/weight loss episodes that obese persons undergo. By age 50, nearly 50% of morbidly obese women have developed gallstones.
  • Bowel obstruction due to a blockage from adhesions (scar tissue) can occur after any abdominal operation.
  • Internal hernia, where the bowels could get twisted inside the abdomen and possibly cut of the blood supply, may lead to surgery to fix the problem. This is a serious condition that needs to be diagnosed immediately otherwise segments of the bowel may die and will need to be removed.
  • Stomal ulcer is an acid-peptic ulcer that occurs on or near the anastomosis (connection) between the stomach pouch and the bowel, "the stoma." An ulcer may also rarely occur in the usual duodenal ulcer position. There is a higher risk of developing ulcers after bariatric surgery. Patients who use non-steroid anti-inflammatory drugs (NSAID) such as ibuprofen, AleveŽ, etc. and smokers have a even higher incidence of ulcers. It can be treated with the same kind of drugs that are currently so popular for the treatment of duodenal and stomach ulcers. Only rarely is surgery required as treatment. Be aware that an untreated stomal ulcer may lead to perforation.
  • Late stomal stenosis, or narrowing of the outlet of the stomach pouch, is a complication that can occur in gastric bypass patients. This complication can often be resolved by scheduling an outpatient procedure and performing an endoscopic balloon dilatation. Under sedation, a scope (1/2-inch diameter tube with a camera) is placed through the mouth and into the stomach pouch. The stricture is then dilated with a balloon. This is sometimes repeated several times over a few weeks. In extreme cases re-operation may be necessary.

Iron deficiency anemia is a complication of significance in the long term. It is almost always preventable. It is not difficult to treat, but must be recognized in order for it to be treated. This is one of the important reasons for long term follow-up.

Adverse events

A number of less serious complications can also occur. These may have little effect on how long it takes you to recover from surgery. These are considered to be non-serious and may include the following:

  • esophagitis (inflammation of the esophagus)
  • gastritis (inflammation of the stomach)
  • hiatal hernia (some stomach above the diaphragm)
  • pancreatitis (inflammation of the pancreas)
  • abdominal pain
  • incisional hernia
  • redundant skin
  • dehydration, diarrhea (frequent semi-solid bowel movements)
  • abnormal stools
  • constipation
  • flatulence (gas)
  • dyspepsia (upset stomach)
  • eructation (belching)
  • wound infection
  • cardiospasm (an obstruction of passage of food through the bottom of the esophagus)
  • hematemsis (vomiting of blood)
  • asthenia (fatigue)
  • fever
  • chest pain
  • incision pain
  • contact dermatitis (rash)
  • abnormal healing, edema (swelling)
  • paresthesia (abnormal sensation of burning, prickly, or tingling)
  • dysmenorrhea (difficult periods)
  • anemia (low oxygen carrying part of blood)
  • cholelithiasis (gallstones)
  • esophageal ulcer (sore)

Be sure to ask your surgeon about these possible risks and complications and any of the medical terms that you don't understand.

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