Risk of Surgery
There are risks that go with any type of medical procedure and surgery is no longer an exception. Success of surgery depends upon 3 factors: type of disease/surgery, experience of surgeon and overall health of patients. The risks of each procedure need to be considered in the light of potential reductions in mortality, morbidity or co-morbidity, quality of life and productivity.
- The most common complications of Gastro-intestinal (bariatric) surgery include anastomotic and staple-line leaks (3.1%), wound infections (2.3%), pulmonary events (2.2%) and haemorrhage (1.7%). Morbidity rates are lower after laparoscopic procedures, which constitute a steadily increasing proportion of bariatric operations. (Nguyen NT et al. Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers.J Am Coll Surg2007;205: 248–255).
- Early post-operative morbidity and mortality are related to the complexity of the surgery. The US Bariatric Outcomes Longitudinal Database (BOLD) reviewed over 57 000 consecutive procedures and reported one or more complication at 1-year rates of 4.6, 10.8, 14.9 and 25.7% following laparoscopic adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass and bilio-pancreatic diversion, respectively. (DeMaria EJ. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Out-comes Longitudinal Database.Surg Obes Relat Dis2010;6: 347–355)
- The 30-day mortality associated with Gastro-intestinal (bariatric) surgery is estimated at 0.1–0.3%, a rate lower / similar to that for laparoscopic cholecystectomy & described as ‘low’. Thirty-day post-surgical mortality is 0.1% for laparoscopic adjustable gastric band, 0.5% for Roux-en-Y gastric bypass and 1.1 for bilio-pancreatic diversion. (Buchwald H et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery 2007;142: 621–632).
- Long-term concerns, especially with Roux-en-Y gastric bypass and bilio-pancreatic diversion, include vitamin and mineral deficiencies, osteoporosis and, rarely, Wernicke’s encephalopathy and severe hypoglycaemia from insulin hypersecretion.