The complications of bariatric surgery: an OBSM discussion

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February 2019 blog (by Dr. Neil Floch)

The complications of bariatric surgery: an OBSM discussion

The incidence, perception, and treatment of complications after bariatric surgery are feared but rarely discussed by professionals on social media. Skeptics cite complications as the major reason to not pursue surgery even though surgery may significantly improve overall health and quality of life. This month, we aim to discuss these potential complications and their management.
Initial results of the Swedish Obesity Study, a longitudinal study comparing diet versus bariatric surgery, were published in The New England Journal of Medicine in 2007. The study compared the rate of mortality in over 4000 patients who had had bariatric surgery to a group of control patients who pursued a healthy diet with exercise. It was clear that 16 years after the start of the study, patients with severe obesity were more likely to be alive if they had had bariatric surgery. This study established the efficacy of bariatric surgery for long-term health.
No surgery comes without risk, though. Bariatric surgery, like every other surgery, has associated complications that vary in severity. The fear of these complications may impact whether individuals choose to undergo the procedure. Despite the fact that bariatric surgery is as safe as gallbladder removal, the public perception is different. Only 31% of people in a recent poll believed that bariatric surgery is safe.
The American Society for Metabolic and Bariatric Surgery (ASMBS) maintains a database to capture the most severe short-term complications of bariatric surgery such as leakage, blockage, bleeding, and blood clots.  Like with any other surgery, there also can be long-term complications and medical problems which may affect quality of life. These could be gastrointestinal symptoms such as pain, vomiting, heartburn, or diarrhea. There could also be mechanical problems such as blockage, hernias, or ulcers. Other complications migjt be associated with changes in intestinal absorption such as anemia and malnutrition. There can also be issues with the gallbladder or pancreas. The adjustable gastric band has a unique set of complications such as band erosion, slippage and more commonly, heartburn, nausea, and vomiting. Furthermore, there are significant psychosocial changes that occur after bariatric surgery that may not always be recognized. Alcohol addiction is also a potential problem.
Although databases that track surgical outcomes include outcomes beyond the first 30 days, much of the current research has focused on the short-term outcomes. More work should be done to understand the long-term risks. One challenge for this, however, is that patients may not always follow up with their original surgeon, and in our healthcare system those patients' information cannot be tracked.
Despite the potential for complications after bariatric surgery, the majority of patients have a positive, life-improving experience. Recognizing and treating complications is important for both patients and healthcare professionals.
Please join us to discuss the following questions:
  1. Do the procedure-related risks of mortality and complications outweigh the benefit of bariatric surgery?
  1. What are the complications (either short-term or long-term) of bariatric surgery procedures? How can we help patients who experience complications?
  1. What are the psychosocial challenges that may arise after bariatric surgery?
  1. Are there any new surgical procedures being developed that may help to reduce the complications of bariatric surgery?
  1. What can patients and their physicians do to limit bariatric surgery complications?

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