Bariatric Surgery Complications

Short Term Bariatric Surgery Complications

Short term complications are usually those complications that happen within the first 30 days after surgery. Many of these complications are tracked in a Bariatric Center of Excellence.

Dr. Angel M. Caban is the Bariatric Program Director at Ocala Health Center of Excellence and he has a clear understanding of what the program performance is at all times.

Dr. Caban personal short term complication rate since he started at Ocala Health is below 5%. That is well below the national average for this type of surgeries. The national average complication rate is between 7-10%.

Some of these complications are:

• Wound infection
• Urinary tract infection
• Pneumonia
• Blood clots (Deep venous thrombosis or Pulmonary embolism)
• Bleeding
• Heart attack
• Stroke
• Vocal cord damage (Intubation for anesthesia)
• Injury to adjacent organs (Spleen, Liver, Colon, etc)
• Leaks or bowel injuries
• Allergic reactions
• Death

Long Term Bariatric Surgery Complications

Complications that develop 30 days or longer after surgery are considered long term complications. Some of these complications are procedure dependent.  For example, patients that underwent a Lap Band can present with some long term complications that cannot happen in patients without a Lap Band. For that reason, we will outline the long term complications under each procedure. 

Lap Band Complications

The Lap Band surgery was very popular in the early 2000s after it was approved by the FDA as a suitable alternative for weight loss. Now we know that at least half of the patients require the Lap Band to be removed.

The initial or short term complication rate is very low but the long term complication is very high. Fortunately, the Lap Band is completely reversible and the surgery for removal is a fairly easy procedure when done by an experienced bariatric surgeon.

Some of the complications include:

• Band erosion: This can happen when the band is too tight around the stomach and it creates tissue necrosis, ulceration and eventually the band works his way inside the stomach.
• Band slippage: Even though the Lap Band is anchored to the upper stomach during placement the band could move. The stomach bulges on top of the Lap Band causing stomach obstruction and possible necrosis. 
• Difficulty swallowing: When the Lap Band is too tight, the patients can have difficulty swallowing. Usually, this is alleviated by removing some of the fluid inside the band. 
• Dilation of the esophagus: Long term complication of a Lap Band that is too tight. The band is causing a partial obstruction and the esophagus starts to enlarge. If this is not fixed by removing the fluid on the Lap Band or by removing the Lap Band itself the damage can be irreversible. 
• Inability to lose weight: Probably the most common complication after the Lap Band surgery. 
• Weight gain: Many patients will regain all or most of their weight loss. 
• Esophageal reflux: Usually as a result of a tight band.
• Lap Band leak: The Lap Band is a mechanical device. Either the port, the tubing or the band itself can leak the fluid out requiring replacement or removal.
• Port dysfunction or displacement: The port is usually sutured to the abdominal wall but it can move causing difficulty accessing it. 
• Band infection: Lap Band infection can happen as a result of a Lap Band erosion or contamination during port access for band adjustment. 
• Chronic vomiting: Many patients think that this is normal after bariatric surgery. Chronic vomiting is never normal after surgery. Most patient with a Lap Band that experience frequent vomiting need the band adjusted. This is usually secondary to a Lap Band that is too tight. 

Gastric Bypass Complications

The Gastric Bypass is considered the gold standard for weight loss surgery but in recent years its popularity has decreased as more and more patients prefer to go with the less invasive counterpart, the sleeve gastrectomy.

The gastric bypass surgery creates a smaller stomach and reroutes the small intestine to promote weight loss. Because of these anatomical changes, some long term complications can develop. Some patients will experience some of these complications 15-20 years later.

• Stricture or narrowing: The gastric bypass has two connections. One between the new stomach pouch and the Roux Limb (small bowel) and the second one between two loops of the small bowel. That gives two areas for possible narrowing or stricture.
• Pouch enlargement: The stomach wants to be a stomach. It was designed to expand to accommodate more food.  With time the gastric pouch is going to enlarge and it will accommodate more food but it will never go back to the normal stomach size.
• Bowel blockage: Because of the anatomic changes, internal or Peterson hernias can develop and subsequently causing a bowel obstruction. Bowel obstruction can also happen due to adhesions or scar tissue from surgery. Any type of abdominal surgery can cause adhesions. This includes surgery for the gallbladder, appendix, hysterectomy and C sections just to mention a few examples.
• Dumping syndrome: Not every gastric bypass patient will experience the effects of dumping syndrome. Only 50-60% of the patients will get it. Dumping syndrome usually happens after the patient eats or drinks something very sweet. They can experience dizziness, palpitations, explosive diarrhea, sweating, and abdominal cramps. The symptoms commonly last around 20-25 minutes.
• Vitamin/ electrolyte deficiency: Nutritional deficiencies are more prevalent after a Roux en Y gastric bypass when compared to a sleeve gastrectomy. Fortunately, when taking supplemental vitamins, iron, calcium, and Vitamin B12 the total percentage of patients that will develop long term vitamin or electrolyte deficiencies is low. Without replacement of iron, for example, approximately 50% of the patients will develop iron deficiency and 20% will develop iron deficiency anemia. 
• Inability to lose weight: Bariatric surgery is not the easy way out. Hard work and dedication is needed to succeed. Weight regain can happen if the patient goes back to bad eating habits.
• Pregnancy complications: For females of childbearing age the recommendation is not to get pregnant within the first 12-18 months. Some studies have shown no complications with the fetus but pregnancy does hinder the weight loss from the surgery. If you want the best weight loss result, prevent pregnancy as much as possible for the first year at least.
• Medication malabsorption: In the initial phase after the gastric bypass when the malabsorption of nutrients is more pronounce the patient might encounter decrease absorption of some medications. Studies done in patients with kidney transplants showed no increase in organ rejection after Roux en Y gastric bypass. Dr. Angel Caban does remember a patient during his surgical training that had issues with the HIV medications and required a temporary feeding tube to administer the medications during the first year after surgery.
• Stomach ulcer: The incidence of ulcers in the new stomach pouch or the connection between the stomach pouch and the small bowel is around 4%.  Most ulcers will present between 22-36 months after surgery. Dr. Caban has seen ulcer formation as long as 20 years after surgery. That patient required a laparoscopic revision of the bypass due to bleeding from the ulcer after he was started on blood thinners for a heart condition.
• Internal hernias: Small intestine can herniate through defects in the mesentery or other spaces created during the gastric bypass surgery. The incidence of internal hernia is around 15%. Peterson hernias is another type of internal hernias that happen in the spaced between the Roux limb and the mesentery of the transverse colon. The incidence of Peterson hernias is around 7%. The Peterson space is usually closed during surgery, but with significant weight loss some of the fat in the area will go away and Peterson space can reopen allowing small bowel to herniate through the now reopened space. Again, this is rare but it can happen. 
• Weight regain: Most patients will maintain the accomplished weight loss, but approximately 25% of the patients will regain a significant amount of the weight back. Patients need to know this, the only way to prevent weight regain is by staying committed to the process. Long term modifications are the key to success after bariatric surgery.