What are the risks in bariatric surgery?

Most bariatric surgery patients will not experience any complications related to their procedures. However, a small degree of risk, including death, is inherent to all types of surgery and use of anesthesia. Because restrictive procedures are less complicated than combined procedures, they are generally safer and result in fewer complications.

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Mortality
The Journal of the American Medical Association reported in October 2005 that the in-hospital mortality rate among bariatric surgery patients was 0.1 to 0.2 percent. At 30 days post-surgery, mortality estimates ranged from 0.33 to 1.9 percent.

A scoring system recently developed by a Duke University bariatric surgeon appears to accurately predict which patients considering bariatric surgery are most likely to die from the procedure. The system adds up the following five risk factors; patients with four of them are six times as likely to die as those with only one:

• Body mass index. Patients with a BMI of 50 or more are at greatest risk.

• Gender. Men are more likely than women to suffer from conditions such as hypertension, diabetes, and metabolic disorders that can increase surgical risks.

• Age. Older patients, particularly the elderly, are known to be at higher risk for death after bariatric surgery.

• Hypertension. Patients suffering from high blood pressure typically have heart disease or chronic inflammation of blood vessels that can add to the risks of surgery.

• Pulmonary embolus risk. People who have had a blood clot in the lungs, or who are at increased risk for developing such a clot, are at elevated risk.

Roux-en-Y gastric bypass complications
Roux-en-Y gastric bypass surgery is a major operation, associated with an overall complication rate of about 20 percent—meaning that approximately 1 in 5 patients will experience some type of postoperative complication.

Most complications are minor, including urinary tract infection, muscle spasms of the abdominal wall, and nausea, but more significant complications can happen.

• Bleeding requiring the transfusion of blood or blood products occurs in 3 to 5 percent of patients.

• Leakage at the surgical site affects approximately 2 percent of patients.

• Hernia requiring further surgery to repair occurs in fewer than 5 percent of patients who undergo laparoscopic surgery but much more frequently in patients who undergo open surgery.

• Serious wound infection affects fewer than 5 percent of patients.

• Stomach or intestinal blockage occurs in fewer than 5 percent of patients.

As with any major surgery, life-threatening complications occur rarely. These can include:

• Blood clots, which can travel to the lungs, resulting in a pulmonary embolism

• Heart attack

• Leakage from a suture line

• Stroke

It is highly unlikely for the pouch to burst because of overeating.

Although serious complications are usually treated successfully, they can lead to permanent disability or even death. The mortality rate for gastric bypass surgery is 0.5 percent.

Lap-Band® procedure complications
The most frequent risks associated with the Lap-Band procedure are:

• Digestive tract blockage due to band slippage
• Displacement of the port used to adjust the band
• Stomach injury
• Bleeding

Gallstones
Several studies have shown that people who experience significant weight loss can develop gallstones. Although many people with gallstones suffer no adverse effects and may not even know they have them, some surgeons opt to remove the gallbladder during gastric bypass surgery to eliminate this possible complication.

Because removal of the gallbladder during a gastric bypass procedure can be complicated, any potential benefits may be outweighed by risks. Patients who have or are prone to having problematic gallstones should raise this issue with their physician before deciding upon bariatric surgery. These patients may benefit from gallbladder removal or gallstone-dissolving medications.

Suicide
People who undergo bariatric surgery have a higher than normal risk of suicide, according to a 2007 report in the Archives of Surgery. Most of the suicides reported occurred at least a year after surgery. The cause may be an underlying depression that existed before the operation, but the report shows that it's important for patients to receive counseling after the surgery as well as before.