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USC Metabolic & Bariatric Surgery Program

Benefits & Risks

Risks of Surgery

Indications

Bariatric surgery is intended for people who are 100 pounds or more overweight (with a Body Mass Index (BMI) of 40 or greater) and who have not had success with other, less risky weight loss therapies such as diet, exercise, and medications. In some cases, a person with a BMI of 35 or greater and one or more co-morbid condition may be considered for bariatric surgery.

Important Considerations

Bariatric surgery should not be considered until you and your doctor have explored all other options. The best approach to bariatric surgery calls for a discussion of the following:

  • Bariatric surgery is not cosmetic surgery
  • Bariatric surgery does not involve the removal of adipose tissue (fat) by suction or surgical removal.
  • Together, you and your doctor should discuss the benefits and risks.
  • You must commit to long-term lifestyle changes, including diet and exercise, which are key to the success of bariatric surgery.
  • Complications after surgery may require further operations.
  • Patients who underwent bariatric surgery have significantly reduced rates of developing cancer, cardiovascular diseases, endocrinological disorders, infectious diseases, musculoskeletal disorders, psychiatric disorders, and pulmonary disorders.

Surgical Risks for Gastric Bypass and Gastric Banding

As with any surgery, there may be immediate and long-term complications and risks. Discuss the benefits and risks with your healthcare team.

Possible risks associated with abdominal surgery can include, but are not limited to:

  • Bleeding
  • Pain
  • Shoulder pain
  • Pneumonia
  • Complications due to anesthesia and medications
  • Deep vein thrombosis (clotting in the veins, commonly in the lower extremities or pelvis)
  • Carbon dioxide embolism
  • Injury to the stomach, esophagus, or surrounding organs
  • Dehiscence (separation of areas that are stitched or stapled together)
  • Infections
  • Leaks from staple lines
  • Marginal ulcers
  • Pulmonary problems, pulmonary embolism
  • Spleen injury (to control operative bleeding, removal of the spleen may be necessary)
  • Stroke or heart attack
  • Stenosis (narrowing of a passage, such as a valve)
  • Death

Potential Risks and Complications After Gastric Bypass

  • Vomiting
  • Nausea
  • Dumping syndrome
  • Nutritional deficiencies
  • Gallstones
  • Diarrhea
  • Increased gas
  • Chest pain
  • Collapsed lung
  • Constipation
  • Abdominal hernia
  • Dehydration
  • Enlarged heart
  • Esophageal spasm
  • Gastrointestinal injury
  • Gastrointestinal swelling
  • GERD (gastrointestinal reflux disease)
  • Inflammation of the esophagus
  • Inflammation of the gallbladder
  • Inflammation of the stomach
  • Kidney tubular necrosis
  • Pain caused by passing a gallstone
  • Stoma obstruction
  • Stretching of the stomach
  • Back pain
  • Depression
  • Difficulty swallowing
  • Fatigue
  • Flatulence
  • General abdominal pain
  • Hair loss
  • Headache
  • Hypertension
  • Inflammation of the nasal passages
  • Inflammation of the sinuses
  • Influenza
  • Insomnia
  • Joint pain
  • Pain after surgery
  • Port site pain
  • Upper abdominal pain
  • Upset stomach
  • Upper respiratory tract infection
  • Urinary tract infection
  • Selective food intolerance
  • Dyspepsia
  • Ulceration
  • Gastroenteritis
  • Reflux esophagitis
  • Gas bloat
  • Esophageal dysmotility
  • Weight regain

Potential Risks and Complications After Gastric Banding

  • Migration of implant, which includes band erosion, band slippage, and port displacement
  • Tubing related complications, which include port disconnection and tube kinking
  • Abdominal hernia
  • Band leak
  • Chest pain
  • Collapsed lung
  • Constipation
  • Dehydration
  • Enlarged heart
  • Esophageal spasm
  • Gallstones
  • Gastrointestinal injury
  • Gastrointestinal swelling
  • GERD (gastroesophageal reflux disease)
  • Inflammation of the esophagus
  • Inflammation of the gallbladder
  • Inflammation of the stomach
  • Kidney tubular necrosis
  • Pain caused by passing a gallstone
  • Port site infection
  • Pulmonary embolism
  • Stoma obstruction
  • Stretching of the stomach
  • Surgical procedure repeated
  • Vomiting
  • Back pain
  • Constipation
  • Depression
  • Nausea
  • Difficulty swallowing
  • Fatigue
  • Flatulence
  • General abdominal pain
  • Hair loss
  • Headache
  • Hypertension
  • Inflammation of the nasal passages
  • Inflammation of the sinuses
  • Influenza
  • Insomnia
  • Joint pain
  • Pain after surgery
  • Port site pain
  • Upper abdominal pain
  • Upset stomach
  • Upper respiratory tract infection
  • Urinary tract infection
  • Selective food intolerance
  • Dyspepsia
  • Ulceration
  • Gastroenteritis
  • Reflux esophagitis
  • Gas bloat
  • Esophageal dysmotility
  • Weight regain
  • Fluid leakage from the balloon or tubing
  • Esophageal dilation
  • Gastric prolapse
  • Fistula
  • Diarrhea

According to the American Society for Metabolic and Bariatric Surgery 2004 Consensus Statement, the operative morbidity (complications) associated with Roux-en-Y gastric bypass in the hands of a skilled surgeon is approximately 5%, and the operative mortality (death) is approximately 0.5%.

For gastric banding, the same consensus statement reported that, in the hands of a skilled surgeon, the operative morbidity is approximately 5% and operative mortality is approximately 0.1%.

 

Compare Mortality Rates

Procedure   Mortality Rate   Occurs In...
Gastric banding   0.1%   1 out of every 1,000 people
Gastric bypass   0.5%   1 out of every 200 people
Hip fracture repair   3.3 to 8.2%   6 out of every 200 people
   

 

Why Would I Have an Open Procedure?

In some patients, the laparoscopic or minimally invasive approach to surgery cannot be used.

Here are reasons why you may have an open procedure, or that may lead your surgeon to switch during the procedure from laparoscopic to open:

  • Prior abdominal surgery that has caused dense scar tissue
  • Inability to see organs
  • Bleeding problems during the operation

Based on patient safety, the decision to perform the open procedure is a judgment made by your surgeon either before or during the actual operation.

 

How to Cope with Surgical Risks and Physical Changes

It’s normal and natural to fear surgery, anesthesia, or physical changes. But before you let these fears prevent you from having bariatric surgery, you may want to take a few moments to better understand the facts.

Fear and Risks of Surgery

This is a common fear. After all, bariatric surgery is major surgery performed while you’re under general anesthesia. Complications can occur. Keep in mind that you’ll have a team of healthcare professionals dedicated to your best possible care.

Keep in Mind

  • Advances in bariatric surgical technique have significantly lowered the risk of operative mortality—especially when surgery is performed by an experienced laparoscopic surgeon.
  • During the past decade, patient outcomes from general anesthesia have improved significantly, so that the mortality rate is down, from one in 10,000 to one in 250,000 patients.Each patient's anesthesiology risk during bariatric surgery is based on the patient’s overall health.

Compare the benefits of bariatric surgery to the risks, and then talk to your doctor about your options.

Fear of Physical Changes

For people who have spent years living with morbid obesity, bariatric surgery sounds like a lifesaver. But, some people are concerned about changing their body. It’s understandable. Your surgeon will reduce the size of your stomach so that you are able to be satisfied with less food and, depending on the procedure, absorb fewer calories and nutrients.

Compare the benefits of bariatric surgery to the risks, and then talk to your doctor about your options.

Be sure to share your concerns with your bariatric surgeon and your bariatric program’s mental health professional. They will be able to provide you with information to help you deal with your concerns.

And Remember…

Bariatric surgery is a lifelong change. Even considering it is a healthy step, because it gives you an opportunity to examine your health and your life.

Tips

  • Research surgeons and bariatric programs: Research your surgeon and program online. Attend different bariatric programs’ support groups and talk to patients to find out their take on the surgeon and the program.
  • Talk to your surgeon: Be honest when speaking with your surgeon. Tell him or her about your fears. Ask about the bariatric program’s complication and mortality rates.


Health Benefits

It’s obvious to many people who have lived with morbid obesity for years that the disease has a severe negative impact on quality of life. Because of morbid obesity, you may choose not to participate in certain activities. You may feel that you have limited career choices.

What you may not know is that morbid obesity has been found to affect the quality of your health and the length of your life.

Morbid obesity has been linked to several serious and life-threatening diseases. These co-morbid conditions include type 2 diabetes, heart disease and high blood pressure, acid reflux/GERD, and cancer. Most of these conditions do not develop for years. So many people living with morbid obesity may have one or more of these health issues without even realizing it.

Bariatric surgery may offer you a whole new outlook on health…

  • One study found that gastric bypass surgery reduced the total number of co-morbid conditions of participating patients by 96%.
  • Many surgeons recommended bariatric surgery as a treatment option for type 2 diabetes. In some cases, resolution of type 2 diabetes occurred within days of the surgery.
  • A meta-analysis stated that several studies found that bariatric surgery patients felt better, spent more time doing recreational and physical activities, benefited from enhanced productivity and economic opportunities, and had more self-confidence than they did prior to surgery.


Type 2 Diabetes

    Gastric Bypass
% of Patients
  Gastric Banding
% of Patients
Type 2 Diabetes Resolved   83.8%   47.8%
   

Long-term Complications

Type 2 diabetes can be a lifelong condition. Type 2 diabetes is an increasingly widespread health issue in the U.S. and has serious long-term consequences. You may want to compare bariatric surgery’s high resolution rates for type 2 diabetes to the long-term effects of the condition.

People with type 2 diabetes are at risk for developing:

  • Heart disease or suffer strokes due to poor circulation
  • Kidney disease and eventually kidney failure, which requires either a kidney transplant or dialysis
  • Nerve damage which can lead to digestive problems, bladder problems, sexual dysfunction, and numbness and tingling
  • Foot problems including blisters, ulcers, and poor circulation, which can lead to amputation
  • Eye complications such as glaucoma, cataracts, and nerve damage, which can lead to blindness

 

Heart Disease and High Blood Pressure

    Gastric Bypass
% of Patients
  Gastric Banding
% of Patients
High Blood Pressure Resolved   75.4%   38.4%
   

Long-term Complications of Heart Disease and High Blood Pressure

Heart disease and high blood pressure are related health conditions. High blood pressure indicates that your heart is straining to pump blood throughout your circulatory system and can lead to health disorders such as heart disease.

Heart disease is an umbrella term for several diseases that affect the heart and the circulatory system. Heart disease can be quite serious and fatal. You may want to compare bariatric surgery’s high resolution rates for heart disease to the long-term effects of these conditions.

People living with morbid obesity are at risk for developing heart disease and high blood pressure, including conditions such as:

  • Coronary artery disease which occurs when the coronary arteries become hardened and narrowed by fatty material; there are rarely any signs or symptoms, so many people with this disease have lived with it for years before the first onset of symptoms, such as a “sudden” heart attack
  • Heart attack which occurs when the heart’s blood supply is interrupted and can damage or completely stop the heart
  • Angina which occurs when the heart does not get enough blood and feels like pressure or squeezing in the chest, shoulders, arms, neck, jaw, or back
  • Arrhythmias which are irregular heartbeats, depending on the type, arrhythmias can lead to death
  • Heart disease including bleeding along artery walls, hardening of the arteries, and heart attack
  • Stroke which is an interruption or blockage of blood to the brain
  • Kidney damage and kidney failure due to damaged blood vessels and which can require a kidney transplant or dialysis
  • Vision loss due to blocked blood vessels to the eye

 

High Cholesterol

    Gastric Bypass
% of Patients
  Gastric Banding
% of Patients
High Cholesterol Improved   95%   78.3%
   

Long-term Complications

Cholesterol is a soft, waxy substance found in all parts of the body. High cholesterol can be harmful and is associated with serious health conditions. You may want to compare bariatric surgery’s high improvement rates for this condition to the long-term effects of high cholesterol.

People with high cholesterol are at risk for developing:

  • Heart disease including hardening of the arteries (atherosclerosis), which is a principle cause of coronary heart disease, and heart attack
  • Stroke which is an interruption or blockage of blood to the brain

 

Obstructive Sleep Apnea

    Gastric Bypass
% of Patients
  Gastric Banding
% of Patients
Obstructive Sleep Apnea Resolved   86.6%   94.6%
   

Long-term Complications

Obstructive sleep apnea is a sleep disorder with symptoms of loud snoring and long pauses in breathing. Often the person with obstructive sleep apnea is unaware of their condition until they’re told by a family member or friend. Obstructive sleep apnea is linked to several serious conditions and experiences. You may want to compare bariatric surgery’s high resolution rates for this condition to the long-term effects of obstructive sleep apnea.

People with obstructive sleep apnea are at risk for:

  • Heart disease due to low oxygen levels in blood
  • High blood pressure due to low oxygen levels in blood
  • Heart attack which occurs because of low oxygen levels in blood
  • Daytime drowsiness which can lower job performance or lead to accidents such as serious car crashes

 

Acid Reflux/GERD

    Gastric Bypass
% of Patients
  Gastric Banding
% of Patients
Acid Reflux/GERD Resolved   98%   32.3%
   

Long-term Complications

Acid reflux, also known as GERD, occurs when the valve between the stomach and the esophagus is not working. Stomach acid splashes up into the esophagus, which can damage it and lead to painful conditions and cancer. You may want to compare bariatric surgery’s high resolution rates for acid reflux to the long-term effects of this condition.

People with acid reflux are at risk for developing:

  • Esophagitis, inflammation of the esophagus, which can cause difficulty swallowing, ulcers, and scarring
  • Barrett’s esophagus which occurs because the lining of the esophagus is damaged by stomach acid and can lead to esophageal cancer
  • Esophageal cancer (adenocarcinoma) is associated with a low survival rate: only 12% of esophageal cancer patients survive for more than five years8

 

Cancer

Morbid Obesity and Cancer Risks

Several studies have been conducted to examine the link between morbid obesity and cancer.

In 2001, experts at the National Cancer InstituteÒ concluded that several cancers are associated with obesity:

  • Colon cancer
  • Breast cancer (postmenopausal)
  • Endometrial cancer (lining of the uterus)
  • Kidney cancer
  • Esophageal cancer (adenocarcinoma)

In 2003, an article in the New England Journal of Medicine estimated that obesity could account for:

  • 14% of all deaths from cancer in men
  • 20% of all deaths from cancer in women

 

A Proven Treatment Option

Several clinical studies of bariatric surgery show that surgery improved life expectancy in patients by at least 29 to 89 percent.

A Note on Relative Risk

The charts below refer to “relative risk,” which compares how likely an event is to occur to a person versus another person. The charts show how much more likely a person with morbid obesity is to develop cancer or die from cancer versus a person with a healthy weight.

National Cancer Institute Found People Living with Morbid Obesity Are More Likely to Develop Certain Cancers Than Healthy Weight People

Type of Cancer   Women   Men
Esophageal cancer (adenocarcinoma)   200% higher relative risk of occurrence   200% higher relative risk of occurrence
Kidney cancer   84% higher relative risk of occurrence   84% higher relative risk of occurrence
Colon cancer   No data available   Increased risk of occurrence
Breast cancer   50% higher relative risk of occurrence   No data available
Uterine cancer   200% to 400% higher relative risk of occurrence   N/A
   

 

Study in the New England Journal of Medicine Found People Living with Morbid Obesity Had Significantly Higher Death Rates from Cancer Than Healthy Weight People

Type of Cancer   Women   Men
All types   62% higher relative risk of death   52% higher relative risk of death
Esophageal cancer (adenocarcinoma)   No data available   63% higher relative risk of death
Kidney cancer   475% higher relative risk of death   70% higher relative risk of death
Stomach cancer   8% higher relative risk of death   94% higher relative risk of death
Colorectal cancer   46% higher relative risk of death   84% higher relative risk of death
Liver cancer   68% higher relative risk of death   452% higher relative risk of death
Pancreatic cancer   276% higher relative risk of death   49% higher relative risk of death
Non-Hodgkin’s lymphoma   95% higher relative risk of death   49% higher relative risk of death
Multiple myeloma   44% higher relative risk of death   71% higher relative risk of death
Leukemia   Lower relative risk of death   70% higher relative risk of death
Breast cancer   212% higher relative risk of death   No data available
Cervical cancer   320% higher relative risk of death   N/A
Ovarian cancer   51% higher relative risk of death   N/A
Uterine cancer   625% higher relative risk of death   N/A
Prostate cancer   N/A   34% higher relative risk of death
   

Cancer and obesity are linked, but there is hope:

  • One recent study that examined the effect of intentional weight loss found that women who experienced intentional weight loss of 20 or more pounds and were not currently overweight had cancer rates at the level of healthy women who never lost weight.
  • Several clinical studies found that bariatric surgery reduced mortality in patients by 29% to 89% when compared to a group of people living with morbid obesity who had not had the surgery.

 

Depression

    Gastric Bypass
% of Patients
  Gastric Banding
% of Patients
Depression Improved   47%   No data available
   

Symptoms and Signs

Clinical depression is a mood disorder during which feelings of sadness, loss, anger, or frustration interfere with everyday living for extended periods of time. This is very different from having a bad day, feeling unhappy, or just “down in the dumps.” You may want to consider bariatric surgery’s improvement rates for this condition.

People with depression may experience:

  • Lower quality of life
  • Sadness
  • Lack of interest in, and withdrawal from, usual activities
  • Feelings of hopelessness
  • Lack of energy
  • Difficulty concentrating
  • Difficulty making decisions
  • Insomnia or excessive sleep
  • Stomach aches and digestive problems
  • Sexual dysfunction
  • Thoughts of death, suicide, or self-mutilation


Osteoarthritis and Joint Pain

    Gastric Bypass
% of Patients
  Gastric Banding
% of Patients
Osteoarthritis and Joint Pain Resolved   41%   No data available
   

Long-term Complications

Osteoarthritis is also known as degenerative joint disease. It results in the breakdown of the cartilage in the joints. Without cartilage, the bones rub against each other, and the joints become stiff and painful. You may want to consider bariatric surgery’s resolution rates for osteoarthritis and the long-term effects of the condition.

People with osteoarthritis are at risk for developing:

  • Muscular atrophy due to the reduced range of movement caused by pain and stiffness in the joints
  • Loss of mobility because osteoarthritis commonly occurs in the hips, knees, and spine, making it harder and more painful to walk and move around
  • Joint swelling caused by the friction of bones rubbing against each other

 

Stress Urinary Incontinence

    Gastric Bypass
% of Patients
  Gastric Banding
% of Patients
Stress Urinary Incontinence Resolved   44%   No data available
   

Symptoms and Signs

Stress urinary incontinence can be an embarrassing health issue that can disrupt social activities and careers. It is an involuntary loss of urine that may occur during physical activity, such as coughing, sneezing, laughing, and exercise. You may want to consider bariatric surgery’s resolution rates for this condition.

 

Female Reproductive Health

You may want to consider bariatric surgery’s resolution rates for these conditions and the long-term effects of reproductive health.

In a study of 28 patients with Polycystic Ovarian Syndrome who had gastric bypass surgery, the following results were reported.

    Gastric Bypass
% of Patients
  Gastric Banding
% of Patients
Menstrual Dysfunction Due to Polycystic Ovarian Syndrome Resolved   100%   No data available
Excess Hair Due to Polycystic Ovarian Syndrome Resolved   79%   No data available
Restores ovulation and fertility   Yes
5 of 5 patients (100%)
  No data available
   

Women living with morbid obesity may experience certain reproductive health issues, such as:

  • Menstrual dysfunction due to polycystic ovarian syndrome (PCOS)
  • Excess hair (also known as hirsutism) due to PCOS
  • Infertility

 

Additional Health Benefits

You may want to compare bariatric surgery’s resolution rates for these conditions to the long-term effects of these health issues.

Metabolic Syndrome
Also known as syndrome X, metabolic syndrome is a group of risk factors including high blood pressure, high blood sugar, unhealthy cholesterol levels, and abdominal obesity. People with metabolic syndrome are at risk for developing:

  • Heart disease, including hardening of the arteries, which can lead to heart attacks and stroke
  • Diabetes which can lead to kidney failure, amputation of feet, and blindness

80% of gastric bypass patients experienced complete resolution of metabolic syndrome after surgery.

Migraines
Migraines are throbbing headaches that can last up to 48 hours and are often accompanied by vomiting, nausea, loss of appetite, tiredness, and sensitivity to light and sound. While migraines are not generally considered a significant threat to overall health, they are associated with a lower quality of life. People with migraines are at risk for developing:

  • Stroke, an extremely rare complication of severe migraines.

57% of gastric bypass patients experienced complete resolution of migraines after surgery.

Venous Stasis Disease
Venous stasis disease occurs when the veins have problems sending blood from the legs back to the heart. Fluid seeps out of the overfilled veins into surrounding leg tissues and cause tissue breakdown and ulcers. And because skin ulcers are the result of poor blood circulation, these wounds are often slow to heal. People with venous stasis disease may experience:

  • Painful ulcers
  • Rashes
  • Leg pains
  • Dark red or purple skin over the affected area
  • Skin may become thickened, dry, and itchy

95% of gastric bypass patients experienced complete resolution of venous stasis disease after surgery.

Pseudotumor Cerebri
Pseudotumor cerebri is a condition that appears to be a tumor—but it is not. The major symptom is increased pressure within the skull; other symptoms include headache, buzzing sound in the ears, dizziness, and nausea.

  • Vision loss can occur with this condition.

96% of gastric bypass patients experienced complete resolution of pseudotumor cerebri after surgery.

 

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