What are the Risks, complications, and adverse events?

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

What are the general risks?

OBESITY SURGERY includes the same risks that come with all major surgeries. There are also added risks in any operation for patients who are seriously overweight. You should know that death is one of the risks. Your age can increase your risk from surgery. So can excess weight. Certain diseases, whether they were caused by obesity or not, can increase your risk from surgery. There are also risks that come with the medications and the methods used in the surgical procedure. You also have risks that come from how your body responds to any foreign object implanted in it.

Rapid weight loss may lead to symptoms of: Malnutrition & Anaemia,gallstones. It is important you stick to a high protein, low fat and low carbohydrate diet. Anti-inflammatory drugs that may irritate the stomach, such as aspirin and NSAIDs, should be used with caution. Vitamin, iron & calcium supplements may be required.

• Perforation of the stomach or oesophagus during surgery
• Damage to major blood vessels
• Lung problems - much less because of less pain and early ambulation
• Thrombosis (blood clots). DVT/Pulmonary embolism – less common than open
• Spleen damage - less common than open
• Inability to do the operation Laparoscopically

Is there a chance the band will need to be removed?

The GASTRIC BAND is a long-term implant, but it may have to be removed or replaced at any time. For instance, the device may need to be removed to manage any adverse reactions you might have. The device may also need to be removed, repositioned or replaced if you aren't losing as much weight as you and your doctor feel you should be losing.

Possible Late Gastric Banding Complications:

• The band can spontaneously deflate because of leakage. That leakage can come from the band, the reservoir, or the tubing.
• The band can slip. Stomach may come through it. The stomach pouch can enlarge. The pouch could become gangrenous and perforate resulting in peritonitis. Band may have to be removed, repositioned or removed and converted to bypass/sleeve gastrectomy/DS
• Ulceration/The band can erode into the stomach. Remove Band
• Gastritis (irritation of stomach). May need antacids/PPIs
• Heartburn/ gastroesophageal reflux (regurgitation)
• Dysphagia (difficulty in swallowing). Band may have to be deflated.
• Dehydration due to vomiting. Band may have to be deflated
• Constipation due to the altered food and low fluid intake.
• Weight regain due to going back to old habits or becoming sweet eater or band is loose.
• Nutritional deficiencies if not taking a balanced diet.

Obstruction of the stomach can be caused by: Food , Swelling, Band erosion, the band being over-inflated, Band or stomach slippage / Stomach pouch enlargement, Stomach pouch twisting. Tightening the band too fast or too much to try to speed up weight loss should be avoided. The stomach pouch and/or oesophagus can become enlarged as a result; it may cause erosion of the stomach. You need to learn how to use your band as a tool that can help you reduce the amount you eat. Some patients have more nausea and vomiting than others. You should see your physician at once if vomiting persists.

IMMEDIATE:

The main risk from these surgeries is the leak from the join or staple line. This causes peritonitis which requires further surgery and intensive management.

Dumping Syndrome

Dumping Syndrome is a condition that can cause unpleasant symptoms such as diarrhoea, nausea, light-headedness, cold sweats, weakness, tiredness, fast heart rate and stomach cramping. This occurs in the gastric bypass patients when foods pass too quickly from the stomach into the small intestine. Dumping Syndrome can be caused by eating foods high in sugar or fat, or by drinking liquids and solids together after gastric bypass surgery. Regardless of the surgery, foods high in sugar and fat content are discouraged due to the high calorie content.

Nausea /Vomiting/Pain

This is often caused by eating too much or too fast. Following surgery, patients will not be able to eat the quantity of food they presently eat. Other causes of nausea and vomiting include ulcers or stricture, as well as drinking liquids with foods, and not chewing or blenderizing foods well enough. Be sure to eat in a slow, calm manner. If vomiting, nausea or pain persist, contact your doctor to rule out ulcers or stricture (narrowing).

Hair Loss

Hair loss is a side effect of weight loss surgery. You may not see hair loss initially. Often it takes several months after surgery for hair loss to begin. Hair loss should resolve when weight and nutritional intake stabilizes. Hair loss can occur from a low protein and zinc intake, and a severe decrease in overall nutrition. It is important you eat foods high in protein and take a daily multivitamin/mineral supplement which provides a source of zinc.

Constipation

Constipation after gastric bypass surgery and restrictive procedures is common and should be prevented. Decreased intake of food, fibre and fluid along with iron and calcium supplementation can lead to constipation. Your doctor may recommend a stool softener or laxative. 1. Drink plenty of fluid. 2. Exercise regularly. 3. Try baby food prunes or unsweetened prune juice, applesauce or oatmeal.4 Once you start on a regular diet, you can start eating high fibre foods; Chew all fibre-containing foods to a paste consistency. 7. Drink plenty of fluids when increasing fibre in the diet.

Lactose Intolerance

Some people may experience intolerance to milk products after some types of weight loss surgery. Symptoms are gas, cramps and diarrhoea. This occurs if the body is not making enough of the enzyme lactase. Lactase is the enzyme needed to digest milk sugar or lactose. Some people may become intolerant to some but not all milk products. Should lactose intolerance occur, soya products or products that are lactose free or low lactose can be used. There are also tablets, which if chewed well can be used before dairy containing meals to improve tolerance to lactose.

Food Intolerance

Some common problem foods are red meat, bread, pasta, rice and the membrane of citrus fruits. Toasted bread is better tolerated than untoasted bread. Red meat should be tried last. Red meats are high in muscle fibre, which is difficult to separate even with a great deal of chewing. Always be very careful and chew well.

Loss of Muscle Mass

Loss of muscle mass can occur after weight loss surgery, but it is preventable. It is very important to exercise after surgery. After weight loss surgery, the body is trying to combat starvation and will consume unused muscle for energy and you will lose muscle mass and strength. It is important to start walking as soon as you go home. Always follow your physician's advice on when to exercise

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