Bariatric surgery problems
Bariatric surgery is effective but it requires some big lifestyle changes. Without these, patients can continue to struggle with obesity.
Complications during or shortly after surgery may include:
- Damage to any of the surrounding organs
- Leak from the anastomosis (join) or staple line
- Chest infection
- Deep vein thrombosis
- Portal vein thrombosis
- Pulmonary embolism
- Spasms or colic in the oesophagus and stomach
Side effects from surgery may include:
- Reflux and heartburn
- Hiatal hernia
- Stomal ulcers which may bleed or perforate
- Internal hernia which can cause bowel obstruction
- Stomach kinking or twisting
- Vitamin deficiencies
- Mineral deficiencies
- Anaemia Pouch dilatation
- Erosion of band
- Port or tubing infection
- Port flip
- Port blockage
- Oesophageal dilatation
- Postural hypotension
This list is by no means exclusive and whilst many are general issues some are procedure specific. Each complication needs diagnosing and managing as best as possible. They are often not easy to diagnose or treat. A range of investigations may be required such as:
- Specific blood tests
- Functional liquid and solid barium test
- CT scan
- Ultrasound scan
- Gastric emptying studies
- Oesophageal manometry studies
- Diagnostic Laparoscopy
Bariatric surgery problems
Failure to lose weight and weight regain
Despite being a powerful tool to aid weight loss there is always going to be some variability in outcomes simply because we are all genetically different.
We are also human and being human, we have the ability to reason. Unfortunately we can use our reasoning to be unreasonable and unrealistic. We have the capability of trumping most of the effectiveness of surgery by ignoring cues and sensations and sometimes by sheer bloody mindedness. Almost to the point of self sabotage.
Having said this, it may not be you failing the procedure it may be the procedure failing you. There may have been a suboptimal procedure performed or there may have been an inappropriate procedure performed.
An early complication, perhaps unrecognised, may have occurred. A hidden trigger or hormonal imbalance may be a miss. Even an innocent change in medication may have caused or have a significant contribution to a failure to lose enough weight, cause weight regain or have resulted in other complications or side effects.
The answer to suboptimal weight loss or weight regain is not to jump into more surgery it is to try and work out the why and the how it occurred and then if we can resolve it and how to make sure it does not happen again.
"Perhaps the biggest issue is the psychological impact if your goals aren’t met. Bariatric surgery is the most effective option but it requires some big lifestyle changes and a lifetime commitment. Without these changes, patients can continue to struggle with obesity and its consequences.
Obesity is a chronic disease that is caused by your biology (DNA) and your interaction with the modern world. In particular the modern food processing methods and high carbohydrate additives. If you go back to old ways the same consequences will eventually ensue. Doing the same as you used to, or not changing what you did results in the same outcome!"
This is why a multidisciplinary approach with regular nutritional and psychological support after surgery is important to help achieve optimal outcomes.
Which surgery problems can you help me with?
At the end of the day these are complications related to upper GI surgery. It just happens to be Upper GI surgery for weight loss. The commonest diagnostic and treatment modality for bariatric complications is an endoscope.
As trained and specialised Upper GI surgeons and as trained and credentialed interventional endoscopists we believe we are in the best position to help in the diagnosis and management of any bariatric surgery related complication. Make an appointment and we'll do our best to advise and treat you.
"A good surgeon will always look at the complete picture. The same should be true for a Bariatric surgeon. We’ll assess your lifestyle, diet and operation. We’ll look at psychological factors that might affect successful outcomes. At Upper GI West, we look at you as a person. Our advice and treatment will be based on your personal situation."
If lifestyle and other reasons for failure of weight loss, weight regain, complications or side effects have been optimised then further surgery may be contemplated. We are happy and able to perform any procedure if deemed logical and sensible.
Further bariatric or more powerful metabolic surgery may be recommended. Because more powerful procedures have increased risks we require a commitment to undertake regular follow up and support and it is essential that you are prepared to follow the instructions of our team. This includes making the required dietary changes such as higher protein intake and taking the recommended lifelong vitamin and mineral supplements which will need to be monitored annually with specific blood tests.
Choosing a surgeon for revision surgery
If you are contemplating revision surgery you have had a less than adequate response from your original surgery.
Reasons may have been beyond your control and complex. Further surgery will certainly be more difficult and optimising you for that surgery and beyond will need more planning.
Do not rush into more complex surgery with its inherent increased potential for more complications without due care and consideration and without a firm plan from your surgeon. If it does not make sense or you are unsure do not go ahead.
If you have decided to go ahead then ask your surgeon about their training and abilities and their plan for you.
- What is their leak rate?
- What is their complication rate?
- How did they manage the complications?
- How long do they expect to take for the procedure and how many patients are on their list?
- Are you part of a dual list or not (where one surgeon uses 2 simultaneous operating theatres with patients asleep)?
- What is their skill in helping you if there is a complication and what do you do if there is an issue?