Weighing the Risks
More than ever, obese patients are turning to gastric bypass surgery. The results can be striking, but it's not a slam-dunk
The results can be impressive: Patients typically lose 100 pounds or more the first year when their appetites are almost nonexistent, for reasons doctors can't quite explain. Hypertension and troubles related to joints improve dramatically, and 85 percent of people who have diabetes before surgery see blood sugar levels return to normal. The transformation can't be overstated. "Before the surgery, I couldn't take 10 steps without having to rest," says Swartz. "I couldn't clean the house, bring in the groceries, or do much of anything but sit on the couch. That's all over now."
But the surgery is risky and can be deadly, facts that can get lost in the din of doctors and hospitals pitching the operations like the latest fad diet. Short-term death rates range between 1 and 2 percent. In the past three years, patient deaths have prompted several hospitals to suspend or revamp their weight-loss surgery programs, and some insurers have stopped paying for the operation. Iowa Methodist Medical Center in Des Moines, for instance, halted bariatric surgery in late 2004 after seven patient deaths. The program was reinstated in January with tougher standards for surgeons, who must perform at least 100 weight-loss operations to qualify, and stricter guidelines for patients, who must be both morbidly obese and suffering from a serious obesity-related illness.
Concerns among the medical profession about the risks and rapid growth of the surgery are increasing. "These mom and pop shops are opening up, performing risky procedures, and leaving patients with a lot of complications," says Craig Albanese, head of pediatric surgery at Lucile Packard Children's Hospital at Stanford University. In the first federal study of its kind, the National Institute of Diabetes and Digestive and Kidney Diseases recently began a four-year study of the operation at six medical centers. "Hospitals developed programs for bariatric surgery before there had been explicit review of what makes it safe, what are the criteria for surgeons to do it safely, and who are the right patients for the procedure," says Paula Griswold, executive director of the Massachusetts Coalition for the Prevention of Medical Errors. "There's more recognition now of what needs to be done, but even more is still needed."
Patients often suffer post-surgical complications, some of them life threatening. The most common ones include bleeding, blood clots, bowel obstructions, hernias, and severe infections. Studies have shown that 10 to 20 percent of patients need additional surgery for such complications. Sandy Pierce, who went from 302 pounds to 126 pounds after gastric bypass surgery in 2001, knows that all too well. She has had eight surgeries in five years to deal with bowel obstructions and hernias. Last year, after her weight dropped to 104 pounds, Pierce had her bypass surgery reversed, but her stomach wouldn't function properly. She also has endured numerous problems stemming from vitamin deficiencies. "The first two years were great, but then the problems began, and they never stopped," says Pierce, 42, who is no longer able to work and depends on a feeding tube. Although Pierce, who had an "open" gastric bypass rather than the less invasive and less risky laparoscopic procedure, is an extreme example, she is not an isolated case. "There are bad outcomes," says Trace Curry, a bariatric surgeon and director of the Deaconess Hospital Surgical Weight Loss Center in Cincinnati. "But for every bad gastric bypass story, there are 1,000 good ones."