Risks and Benefits of Gastric Bypass:

Risks of Roux En Y Gastric Bypass:

The Roux En Y Gastric Bypass is a major operation and does carry risk of complications
and rarely even death which are associated with any general anesthesia or major
abdominal surgery. The risk is approximately the same as having your gallbladder
removed or undergoing a hysterectomy. The risk of general anesthesia in morbidly obese
patients occurs regardless of the type operation and aren’t unique to bariatric surgery.
Patients who are over weight and have their appendix or gallbladder removed, or undergo
a hysterectomy have the same risk. The risk of a major complication overall is around 5-
8% over your lifetime from all causes. These risks can be relatively minor like a kidney
infection or slow healing of an incision, all the way up to a serious life threatening
complication. The most serious complications which occur early are pulmonary emboli
or blood clots which can break free from the legs and travel to the lungs (0.1%); bleeding
requiring further treatment such as a transfusion or re-operation (1%), or leaks and
infections from the GI tract, suture or staple lines (0.25%). The most common cause of
death after any bariatric surgery procedure is a pulmonary embolus (1/1000 patients on
average), despite the fact we give our patients both injectable blood thinner and use
special compression boots (SCD’s or Sequential Compression Devices) to massage the
legs through out the hospitalization. This risk occurs with any over weight patient who
has surgery for any reason and can’t be prevented. The second most common cause of
death after gastric bypass is from a leak or infection. Staple line and suture line leaks, or
perforations from any cause can result in peritonitis which can result in multiple re-
operations, a prolonged hospitalization, and even death. (We have had 6 leaks in 2400
cases or 0.25%). We have had 5 deaths in our first 2400 cases over the past 15 years
(0.2%). This is less than half the national reported incidence of 0.5% in most studies.
Three patients died from pulmonary emboli despite receiving blood thinner, one patient
died from a staple line leak at home after she refused to return to the hospital for
treatment and one patient died from heart failure 2 months after surgery. His cardiologist
had given him 2 months to live before surgery due to severe end stage heart disease which
needed a heart transplant, but the surgeon wouldn’t do a transplant unless he lost weight
first. Risk factors for surgery include being male, age over 50, weight over 400 pounds
or BMI over 60, and having certain Co-Morbidities such as hypertension, heart or
pulmonary disease (sleep apnea), or history of blood clots or venous stasis disease in the
legs.

Long term risks which may require reoperation or reversal to correct include:

1). Developing a bowel obstruction due to adhesions or scar tissue associated with
surgery, or due to an internal hernia due to the creation of the “Y” Roux limb. This can
be very hard to diagnose in severely overweight patients and may not be apparent on
xray exams therefore anytime a post op patient experiences abdominal pain or nausea and
vomiting that lasts more than 4 hours, they need to contact us.
2) Develop a marginal ulcer where the pouch and small bowel are joined. There is an
increase risk of this after Gastric Bypass and patients should stop smoking and avoid
aspirin, NSAIDS and steroids unless they take medications (Proton Pump Inhibitor or
PPI) to protect the stomach. Even with medication the risk of an ulcer is still increased.

3) Development of malnutrition, anemia, vitamin deficiencies or metabolic bone disease
due to inadequate supplements. (NOTE: We test all our patients before surgery and
over 25% have iron deficiency anemia preop, 30% have metabolic bone disease or thin
bones, and 50% have vitamin D deficiency). Patients are at risk for iron, calcium and B
vitamin deficiencies (but not only limited to these) due to the bypass of the upper small
bowel called the duodenum. This may require special nutritional feeding or surgery to
correct in rare instances. We recommend females not get pregnant for 18 months until
their weight loss has stabilized to prevent any nutritional deficiencies or birth defects
in the fetus. After 18 months the risk of pregnancy returns to normal, where as morbid
obese females have an extremely high risk of infertility, miscarriages and birth defects.
4) Stoma stenosis or a narrowing of the outlet from the gastric pouch can result in chronic
vomiting, solid food intolerance and excessive weight loss, which may require stretching
with a balloon and gastroscopy procedure.
5) Chronic vomiting or diarrhea. This may be the result of a stoma stenosis, over eating
or eating foods like desserts which cause “Dumping Syndrome” which are prohibited
after gastric bypass surgery.
6) Hypoglycemia or low blood sugar occurs in some patients after meals and is a form of
the dumping syndrome. This almost always occurs after consuming sweets, but can occur
in some patients who eat simple carbohydrates like potatoes, bread, rice and pasta. It may
not be apparent until 18-24 months after surgery. It can usually be controlled with diet
modifications.
7) Weight loss failure or dissatisfaction with the restrictions of a Gastric Bypass on diet
and lifestyle which may lead a patient to consider a surgical revision or reversal of their
surgery.
8) Depression, Emotional and Social Issues and “Cross Addiction”. Any bariatric
surgery results in significant behavioral changes and emotional stress and many
patients utilized food prior to surgery to deal with emotions. After surgery this is taken
away and they may struggle emotionally which may worsen depression and in rare
instances lead to suicide if untreated. (See article 1 below for details) Patients may
have been so emotionally dependent on food to deal with emotions that they switch to
another “behavior” such as drinking alcohol, gambling, or having multiple sexual affairs
after surgery; which is called “cross addiction”. This may require intensive counseling
or even inpatient therapy or rehab to learn healthy ways to address these issues. Finally,
bariatric surgery may place stress on a marriage, as one partner undergoes a dramatic
change and the other mate feels threatened and insecure, which can cause discord and
lead to divorce post op.

Benefits of Roux-En Y Gastric Bypass:

Multiple long term studies have documented improved health, resolution of co-
morbidities, improved life expectancy, reduced risk of certain cancers and reduced health
care costs for patients who undergo Roux En Y Gastric Bypass for morbid obesity.
Review these articles:
1 ) Long term mortality after gastric bypass surgery. New England Journal of
Medicine 2007; 357: 753-761.
2 ) Surgery decreases long term mortality, morbidity and health care use in morbidly
obese patients. Annals of Surgery 2004; 240: 416-424.
3 ) The impact of weight reduction surgery on health care costs in morbidly obese