Surgery to produce weight loss is a serious undertaking. Every patient considering weight loss surgery should clearly understand and be aware of what the operation involves both physically and psychologically.
It All Begins with Awareness
The purpose of this instructional material is to educate and make you aware of the risks one consents to when they undergo weight loss surgery. In addition you must be aware of the commitment your surgeon requires you to make in order to live the directed healthy lifestyle essential for long term success.
As you go through these materials it is important to realize that the most serious risks of weight loss surgery are similar to those of ANY type of major surgery. When you consent to weight loss surgery you are indicating that you have been instructed in the common complications associated with the surgery and accept these risks.
Information is given about the lifestyle changes that one must undergo post-operatively. These changes you will experience after surgery include dietary and fitness requirements. You will also experience changes in the emotional and social aspects of your life.
The primary purpose of informed consent is to make sure you understand and are aware of the risk factors associated with the surgery as well as the necessary guidelines you must follow for long-term success.
Your surgeon desires to be your health partner. However, you play the critical role in achieving permanent weight loss. Ultimately the choice is yours to live the required lifestyle of health.
If you are not willing, or think at this time that you may be unable to make these adjustments, then you will only be wasting your time and money while exposing yourself to the unnecessary risks of this surgery.
Risk of Complication
When you consent to undergo weight loss surgery you must be aware that your anatomy will be altered and that the risk of complication is possible. Your surgeon will explain the alteration process. Complications may occur during or after your surgery.
The severity of complications can vary from mild to extreme. Life threatening complications can occur that require intensive medical intervention and may result in death.
All patients, especially cash paying patients, must be aware that complications can cause significant medical costs due to extended hospital stays or additional surgery. You must also understand that insurance companies that exclude coverage for weight loss surgery may deny future coverage of any complications caused as a result of weight loss surgery. Contact your insurance company to verify future coverage as a result of weight loss surgery complications.
Important Risk Factors
People who suffer from morbid obesity often have other medical conditions which are related to obesity. Other medical conditions, termed co-morbidities, can increase the risk of complications occurring with your surgery. They may also be the cause of a longer recovery period. Your surgeon will consult with you regarding the risks of any co-morbid condition(s) you may have.
Another risk factor is age. There is generally a higher risk for older individuals.
Any medical procedure that involves reactions to stress, trauma, and drugs can cause unpredictable negative complications. Your surgeon will assess your current medical status. You and your surgeon will determine if the surgery is appropriate for you.
Please note that it cannot be accurately predicted who will have complications and who will not. Only you can decide if you are willing to accept the risks that are involved with surgery.
Possible Operating Room Complications
Be sure to consult with your surgeon regarding the items listed below:
Allergic Reactions: All kinds of allergic reactions are possible. They range from minor reactions such as a rash to sudden overwhelming reactions.
Anesthesia Complications: Anesthesia is used to put you to sleep during the surgery. Anesthesia can be associated with a variety of different complications as with any surgery.
Bleeding: Surgery involves opening your body, which can create bleeding complications. Bleeding can range from minor to massive. Blood transfusion may be necessary.
Heart Attack: The trauma of surgery on the body can result in a heart attack. Patients who enter surgery with pre-existing cardiac related co-morbidities are at higher risk for complications.
Spleen Removal: The spleen may experience unavoidable damage during surgery and may have to be removed to prevent future problems and the need for additional major surgery.
Gallbladder Removal: If your gallbladder is abnormal in any way, you are giving consent to have it removed to prevent future problems and the need for additional major surgery.
Death: This is major and serious operation. Although death is rare, these complications may lead to death in the operating room or post-operatively.
Possible Post-Operative Complications
Anastamotic Suture / Staple Line Leaks (not band patients): An occasional patient may have a complication relating to the staple line or the outlet of the gastric pouch. For example, there might be leakage, perforation, or bleeding. Other possible complications include; the formation of an ulcer or stricture, or failure of the staple line to heal properly. These kinds of complications may make additional surgery necessary. Even though all precautions are taken to prevent them, occasionally they do occur.
Pneumonia: Pneumonia is an infection in the lung. All patients who are recovering from any type of surgery where general anesthesia is administered are at risk for this post-surgical complication. Walking and breathing, as instructed, after surgery is a preventative measure that is taken for this complication.
Pulmonary Embolism: The obstruction of the pulmonary artery or a branch of it leading to the lungs by a blood clot. The blood clot usually originates from the leg or pelvic veins. It can also be caused by foreign material. Blood clots create a sudden closure of the vessels.
Preventative measures are taken pre, intra, and post operatively. This treatment includes anticoagulants such as heparin and warfarin (Coumadin). Compression (boots) devices may also be used in the hospital. About 10-15% of patients with pulmonary embolism die. Getting up frequently and walking around after surgery is essential to decrease the risk of experiencing a Pulmonary Embolism. Early reporting of leg or chest pain to your surgeon is essential.
Infections: The surgery creates an open wound (or wounds), which can bleed, fail to heal, or become infected. Washing incisions with soap and water lessen risk of infection.
Bleeding: When a blood vessel that has been cut and tied off during surgery reopens, it can create a hemorrhage. Transfusions and/or re-operation may be required.
Vomiting: Some patients may experience pain or vomit after intake of food. In most instances, this is caused by eating too much and too fast. If eating is slow and calm, you will learn to listen to the signals from your stomach pouch. Call the nursing staff if you feel nauseated, have pain, or vomit.
Regular vomiting is a warning sign of obstruction. Initially, vomiting may be caused by swelling at the operative site. Later, there is a possibility that vomiting might be caused by a formation of a stricture, scarring of the outlet of the gastric pouch to the small intestine, ulceration, or by an obstruction of the pouch outlet by a lump of poorly chewed food, tablet, or other foreign body.
In most cases vomiting related complications can easily be corrected without additional surgery. However, re-operation or simple dilation of the outlet may be required.
Adhesions / Bowel Obstruction: All operations involving the abdominal wall will leave behind scar tissue that sometimes places the patient at risk for the development of a bowel blockage or obstruction. The bowel can twist, obstruct and even perforate leading to serious complications. Adhesions sometimes soften up on their own. Occasionally there are instances that some adhesions will require additional surgery to correct the situation and restore bowel function.
Constipation: Many patients feel constipated after surgery. It is normal to have fewer bowel movements after weight loss surgery. Constipation can also be the result of inadequate fluid intake.
Incisional Hernia: Cuts and incisions in the abdominal wall can lead to hernias after surgery. Hernias are a protrusion of fat or bowel through an incision that has pulled apart. Hernias can lead to pain, bowel blockage or obstruction. Treatment of hernias usually requires additional surgery.
Gallbladder Disease: Gallstones may develop requiring a postoperative cholecystectomy. (Removal of the Gallbladder)
Kidney Stones: Some patients experience kidney stones after surgery. Kidney stones are frequently found in individuals who are not drinking enough water. Make sure you are drinking a minimum of 64-ounces of water each day to prevent the formation of kidney stones. If you already have a history of kidney stones, be sure to inform your surgeon.
Caffeine Withdrawal Headache: Caffeine withdrawal has been shown to occur in many patients who drink coffee, tea or sodas. This can happen after surgery and can be a very painful experience. Caffeine is a diuretic and can interfere with your hydration level post-operatively. To avoid this problem stop all caffeine a minimum of 1 month before your surgery.
Dumping Syndrome (not band, sleeve or DS patients): The consumption of sugar and some fats trigger the dumping syndrome for gastric bypass patients. It is an unpleasant physiological reaction to concentrated calories and carbohydrates hitting the intestine. It is characterized by the rapid movement of body fluids into the intestine in response to a high caloric and carbohydrate load. (For more information on Dumping Syndrome, go here).
Vitamin and Mineral Deficiencies: Because of the limitation of vitamins and minerals in food intake, supplemental vitamins must be taken FOREVER. Vitamin and mineral supplementation is necessary to minimize the risk of anemia, weakness, muscular in-coordination, and clinical depression.
Yearly Blood Tests: You must have yearly blood tests to measure the blood levels of these vitamins and minerals. Common deficiencies that can occur after weight loss surgery include iron, calcium, B12 and Folate deficiencies.
The tests you need to have each year are as follows:
- Complete Blood Count
- Lipid Profile
- Comprehensive Metabolic Panel
- B-12 Level
- Thiamine Level
- Folate Level
- Hemoglobin A1-C
- Vitamin-D Level
Duodenal Switch patients should also have the following test done with their annual labs.
- Vitamin A level
Forgetting to take your vitamins can have serious consequences. Deficiencies can become so severe that they can lead to brain or nerve damage. Simply taking a daily multivitamin, a sublingual B-12 (not for band patients), a calcium supplement and having your annual blood work completed is a way to prevent this type of complication from occurring.
Hair Loss: It’s not uncommon for patients to experience hair loss for a period of time after the operation. Hair loss is reported most commonly by patients 3-4 months after surgery. Hair re-growth is seen around 7-9 months post-operatively. Hair loss is usually not a permanent condition. Rarely do patients lose more than 1/3 of their hair.
Depression: Feeling down after major surgery is a common side effect. As weight loss progresses some patients may experience increased anxiety about their body image and interactions with others. Ongoing difficulties may lead to a visit to your primary care physician or treating physician. If any medications are prescribed, be sure your doctor does not prescribe the type that can cause weight gain. Patients have also found it helpful to seek outside help from a psychologist or counselor. Ask RMAP for referrals.
Pregnancy: A weight loss of about 10% in an obese woman is effective in improving menstrual regularity, ovulation, hormonal profiles, and pregnancy rates. If you are sexually active you must use some type of birth control to prevent pregnancy during the first 18 months following weight loss surgery. Pregnancy during rapid weight loss can harm a developing fetus.
Adjustable Gastric Band
You may have risks that come from how your body responds to any foreign object implanted in it. Published results from past surgeries, however, do show that adjustable gastric band surgery may have fewer risks than other surgical treatments for obesity. Patients can experience complications after surgery. Most complications are not serious but some may require hospitalization and/or re-operation.
Recent rates of complications are as follows:
- Band Slippage 5%
- Band Erosion less than 1%
- Tubing or Port Problems 1-2%
- Nausea and/or Vomiting 5-20%
Surgeons with more laparoscopic experience and more experience with weight loss surgery procedures report fewer complications.
Minimizing Your Risks Prior to Surgery
There is no way to eliminate the possible complications and risks of weight loss surgery. With a little planning and effort on your part you may be able decrease the likelihood that complications will occur. You may have a few weeks before you undergo surgery. Utilize this time to prepare your body physically as well as your mind. It is essential that your family, friends, and extended support system be prepared as well.
If you smoke, DON’T!
The surgeons at Rocky Mountain Associated Physicians recommend you refrain from smoking for at least two weeks prior to the surgery. To decrease your odds of pulmonary complications after surgery stop smoking as soon as possible and do not start again. Smokers have been found to have difficulty after surgery with returning to normal pulmonary (breathing) function. Wound healing is also shown to be slower and individuals who smoke experience a higher postoperative incidence of infection. And development of ulcers is also seen in patients who smoke.
Smokers who quit smoking for the surgery and then resume again report more frequent episodes of vomiting, narrowing of the anastomosis, increased scar tissue, and higher risk for ulcers. Smoking is just bad for you all the way around. Stop doing it now! Start living a healthier lifestyle today.
Avoid second hand smoke. If you live with someone who smokes ask them to refrain from smoking in your presence. Responsible individuals will take their smoking outdoors when requested. Some will even quit.
It has been recognized that most traditional diets fail at long term weight loss in the morbidly obese patient. However, losing even 10 pounds prior to your weight loss surgery can decrease the odds of your experiencing problems post-operatively.
The loss of a few pounds can shrink your liver and will give your surgeon more room to maneuver during the operation. This can make significant difference in the laparoscopic approach to weight loss surgery. It may also minimize post-operative hernias, and infections in the open approach.
Discuss pre-surgery diet with your surgeon during your consultation with him.
Avoid the Last Supper Mentality
Many patients who are waiting to undergo weight loss surgery recognize that their diet is about to change. They indulge themselves by consuming mass quantities of all of their favorite foods. The result is a possible increase of your pre-operative weight increasing the risk of complications and points to a possible lack of commitment to your new lifestyle of health.
Your transition to a lifestyle of health started the day that you chose weight loss surgery as a treatment, not the day you are admitted for surgery.
Begin Taking a Daily Multivitamin
Many patients presenting for weight loss surgery have pre-existing nutritional deficiencies. Taking a daily multi-vitamin is a life-long requirement. Starting now will not only improve your pre-operative health but will begin the formation of a habit that must stay with you for the rest of your life.
When choosing a multi-vitamin look for one that easily dissolves in water, and contains adequate quantities of B vitamins and calcium. Name brand varieties usually cost more but are of a higher quality. Since you will be spending less on your grocery bill don’t skimp on the price of your vitamins and supplements.
Consult with your surgeon about exercising prior to surgery. The benefits of exercise can reduce your complication rate significantly by improving strength, circulation and lung capacity. Getting into an exercise routine prior to surgery can reduce the risk of pulmonary complications, recover faster, and actually lose the weight sooner.
For helpful hints on how to curb hunger between meals click here.
Find more answers to Frequently Answered Questions here.