Bariatric Surgery Complications

Like any other surgical procedure, bariatric surgery does come with its share of potential complications. Depending on which bariatric surgery you opt for the complications will vary but there are some typical complications that are common to most weight loss surgeries.

Understanding the risks, and planning for them ahead of time are the best tools you have at being able to manage and overcome anything that should arise. Your doctor will help you understand in greater detail which potential complications are more likely for you based upon your individual situation.

Complications and risks of bariatric surgery can be broken down in to two major groups. There are short term complications that will more commonly be experienced in the period of time immediately following your weight loss surgery. This time frame is typically defined as the 30 days following surgery. The second group are those that fall under long term complications or any complications experienced past 30 days and for the months and years following.

Short Term Complications and Risks

According to a study by the National Institute of Health, Within 30 days of bariatric surgery, 4.1% of patients had at least one major adverse outcome, defined as death, development of blood clots in the deep veins of the legs or in the pulmonary artery of the lungs, repeat surgeries, or failure to be discharged from the hospital within 30 days of surgery.”

Short term complications seem to be heavily influenced by the overall health of the patient leading up to surgery, with those patients who have a higher BMI and larger amount of health conditions at a higher risk of post surgery short term complications.

Short term complications can include:

  • Pneumonia – Excess weight places extra stress on the chest cavity and lungs
  • Blood clots in the legs (venous thrombosis)
  • Infections at the incision site
  • Leaks around the staples

Long Term Complications and Risks

Long term complications can also vary between the different weight loss surgeries and can range from the potentially severe to minor.

Long term complications can include:

  • A narrowing or stricture of the opening (stoma) between the stomach and intestine can occur.
  • A hernia or weakness in the incision can sometimes occur and would need to be surgically repaired
  • Patients may suffer from nutritional deficiencies
  • Frequent dehydration is seen as patients ability to take in fluids is reduced
  • Depression – the psychological aspect of surgery must not be overlooked as people can sometimes have a hard time dealing with such drastic change after surgery

The overall complications and side effects of bariatric surgery can also include common ailments that go along with such a dramatic body transformation. This includes:

  • Nausea
  • Diarrhea
  • Joint soreness
  • Low energy level
  • Hair & skin changes

Your doctor will discuss all of the potential risks that could affect you and your specific surgery and help you understand how to better prepare for your surgery and overcome whatever complications should arise.

What to Expect After Bariatric Surgery

Life after bariatric surgery will be dramatically different than before your procedure, but that is a good thing. While the bariatric surgery itself is obviously the key component of the whole process, it’s how you handle yourself after the surgery that will determine your long term weight loss surgery success. If you neglect to do everything you are supposed to, you will not be able to see the full benefits of your bariatric surgery.

Diet after Bariatric Surgery

After your bariatric surgery procedure you can expect to have a much different diet. This is due to your stomach capacity being greatly reduced, depending on which procedure you opted for. The reduction in the size of your stomach means you physically can’t take in as much food anymore, which means you are prone to becoming full much quicker and can also experience nausea or side effects including “dumping syndrome”.

Immediately after your surgery you will be limited to a mostly liquid diet for the first few days. For the next two to four weeks after this you will be transitioned to a pureed/soft foods diet. This diet does not allow any solid pieces but it is ok to eat foods that can be blended. This can include:

  • beans
  • fish
  • egg whites
  • yogurt
  • cottage cheese

For the next few weeks you can move on to a mix of soft and solid foods. You want to ease in to eating solid foods, as they will be harder on your digestive system and it will take some time to see what your body can tolerate. Finally after about 2 months, you will be able to return to a normal solid food diet, but still at a much smaller scale than you ate pre-surgery.

The key to your diet is changing not only the quantity of food you eat but the quality. You want to focus your diet on healthy, low-fat foods that are low in sugar and that are high in protein. You want to avoid snacking throughout the day and make sure you eat consistent smaller meals.

Exercise after Bariatric Surgery

Exercise is a crucial component to your bariatric surgery success. It is crucial to start an exercise routine as soon after surgery as you can, but first ensure that you have the approval of your doctor to begin. Your doctor will want to ensure that you have healed properly from your procedure and that your body will be able to handle the physical exertion now that you aren’t taking in nearly as much food or calories. Exercise will help the body alter its metabolism and get it use to burning calories naturally and in a healthy manner. It has been proven in studies that patients who exercise after their surgery lose more weight and keep it off longer than those who don’t exercise at all.

Your doctor can help you find a physical therapist who can help you design an initial exercise plan that fits your needs and abilities. Below are some exercise ideas to help get you started:

  • Walking – Walking can be a great first step in to exercising as it something that you know how to do and can provide the cardio benefit that your body needs to help get in to shape.
  • Yoga – Yoga can be a great option for many people as it is a cardio exercise without the impact that running or walking can have on your joints.
  • Swimming – Similar to yoga, this is a low impact exercise that uses the resistance of the water to really give you a better than you’d expect workout.
  • Cycling – Cycling is a good option for people who may have sore feet or weak ankles who can’t jog or walk for long distance.

For more ideas on how you can start your exercise routine, check out our article on Exercising Ideas for People who Don’t Exercise.

Cosmetic Surgery after Bariatric Surgery

With time, after bariatric surgery many patients lose so much weight that they have a significant amount of excess skin that no amount of exercise will remove. This excess skin can appear on the arms, legs, buttocks or torso. Opting for cosmetic surgery is a choice that many people make as this is the only way to remove this excess skin. According to the American Society for Aesthetic Plastic Surgery, there are a variety of surgeries that are typical for post bariatric surgery patients who experience dramatic weight loss. These surgeries include:

  • Face & Neck Lift – After dramatic weight loss, the face skin can become flaccid, resulting in the cheek pads dropping, and jowls forming, resulting in the loss of a defined jaw line. Additionally, the neck can become loose and sagging.
  • Arm Lift – Upper arm excess skin occurs on a drastic weight loss patient and is when skin crosses the arm pit and involves loose skin that extends onto the chest region
  • Breast Lift – A breast lift will raise and firm sagging, flat breasts.
  • Panniculectomy – A panniculectomy is performed to remove the hanging pannus, or apron of skin, from the lower abdomen below the belly button.
  • Lower Body Lift – In one procedure, the sagging skin of the abdomen, outer thighs, buttocks, hips, and waist is corrected.

Mental and Emotional Support after Bariatric Surgery

Due to the drastic change in both your appearance and your lifestyle after bariatric surgery, it is highly recommended that you seek counseling either from a professional or through a support group of people who have gone through a similar experience and are also coping with the drastic body changes that you are experiencing.

Preparing for your Bariatric Surgery

Before you can have your bariatric surgery there are a number of things that need to be done so that you can be fully prepared. Keeping a checklist and running through everything before the day of your surgery will help to ensure that you don’t forget anything and are ready for the drastic life changes that comes with bariatric surgery.

Pre-Op Checklist

  • Clear liquids only. Depending on which surgery you are having it may be up to 48 hours that you must stick to only clear liquids. Clear liquids include water, apple juice, cranberry juice, decaffeinated tea without milk, ginger ale, 7-Up/Sprite, etc.
  • Make sure to pack an overnight bag for up to 3 days in the hospital.
  • Pre-surgery tests. You can expect to have to complete some testing, which can include a Complete Blood Count (CBC), Urinalysis, glucose tolerance, chest x-ray, Electrocardiogram (EKG), and possibly more.
  • Often you will be required to quit smoking.
  • Consult with your doctor about what medicines you can and can not take leading up to your surgery. Often you will be asked to not take aspirin for up to a week before your surgery.

What to Pack for Your Hospital Stay

Depending on what type of surgery you have, your hospital stay can range anywhere from 2 nights to 5 nights with the laparoscopic procedures requiring a shorter hospital stay than an open bariatric procedure. You should talk to your doctor about how long he expects you to stay in the hospital and then pack a bag accordingly. You should always include one extra days worth of clothing just to be safe. Always include the following items in your packed bag.

  • Loose pants
  • Oversized shirts/tops
  • Comfortable shoes that slip on and off easily
  • Toothbrush

This checklist is just a starting point for how you can prepare yourself for your weight loss surgery. Your checklist may vary, depending on the type of surgery you’re having, other medical conditions you may have and your doctors personal preferences.

Preparing for Your Return Home After Surgery

While the tips above are how you can prepare for the surgery itself, you also should be preparing for life after surgery. Below are some items you may want to consider having in your house to help make your life a little easier and more comfortable for when you return home from the hospital.

Grocery List

You may want to pick up some of these items are the grocery store before you have your surgery, that way you don’t have to worry about having the proper food to eat once you get home. You could also make a list for a family member or friend to pick up right before you head home from the hospital.

  • Sugar Free Jello
  • Sugar Free Pudding
  • Plain yogurt
  • Gatorade
  • 2% cottage cheese singles
  • Fat Free 1% Milk
  • Egg substitute (in a carton) or Egg white product
  • Sugar Free Popsicles (Edy’s Fruit Bars, No Sugar Added)
  • Protein Drinks
  • Crystal Light or Sugar Free Kool-Aid
  • Low Fat Soups
  • Applesauce – Sugar Free
  • Carnation Instant Breakfast – Sugar Free (Ready To Drink or Powder)
  • Whole Grain Cereal (Post Bran Flakes, 100% Bran, Shredded Wheat, Kashi)
  • Frozen Vegetables – Not in sauce
  • Margarines (Smart Balance tub or spray, I Can’t Believe It’s Not Butter Spray, Take Control Benecol, Fleishmann’s Olive Oil Spread)
  • Whole Grain Breads (whole-wheat, pumpernickel, rye)
  • Skinless poultry (turkey, ground turkey (Jennie-O), chicken)

Medicine & Supplies to Have at Home

The following medications and supplies could be beneficial to have in the house for when you get home from your surgery.

  • Tums
  • Milk of Magnesia
  • Tylenol
  • Pepto Bismol
  • Assortment of bandages and medical tape
  • Neosporin
  • A clean basin

Miscellaneous Items to Remember

The following are other useful items to keep in mind that could help make your life easier once you return home.

  • Make sure you have someone to drive you home from the hospital – This may seem obvious but you will be in no condition to drive yourself home after surgery.
  • Either hire someone to help keep the house clean or ensure a family member is up to the task – You will not be able to bend, squat and do what’s need to be cleaning your home for a period of time after surgery.
  • Clear all walkways in the house – Especially between the bathroom, bedroom and kitchen
  • Ensure that all the laundry is done before you leave for the hospital
    If you have pets,make sure someone will be able to walk and look after them during and immediately after surgery

Bariatric Surgery Cost

One of the major factors in deciding which bariatric surgery is right for you is the costs involved with each surgery. Bariatric surgery can be very expensive and the costs typically start in the thousands of dollars. Then you have to factor in medication, follow up care, post surgery nutrition costs and potential follow up surgery. As you can see the costs can escalate rapidly.

The other factor to consider is whether or not your insurance company will cover the cost of your weight loss surgery. Some surgeries are more likely to be covered than others. It depends on a few factors that your doctor and insurance company can help sort out with you.

Below is a chart highlighting some of the costs for the variety of weight loss surgeries. These costs can vary based upon the factors below the chart.

Factors Affecting Cost

The costs above are average estimates that can vary based on a number of factors. It is understanding each of these factors that will give you a more accurate expectation as to why your bariatric surgery may end up costing you.

  • Location – Surgery costs can range all over the country depending on your location. Typically surgery prices will reflect the local cost of living. So if you are in an expensive metro area you could expect to pay more than if you are in a lower cost rural area. In addition, many people are opting to travel abroad to have their surgery which can reduce the costs drastically.
  • Surgeon Expertise – Costs can also be influenced by how experienced and knowledgeable your surgeon is. A highly trained, highly experienced surgeon will more likely be in demand for his/her services which can drive the price up.
  • Surgery Facility – The facility you have your surgery performed will also have an impact on cost as a larger hospital will typically cost more for post operative care and for hospital room fees, while a smaller clinic will typically cost much less for similar services.
  • Follow Up Care – While all bariatric surgeries require follow up care and monitoring, some are more involved than others. For example, gastric banding procedure can require up to 6 band adjustments per year which each require a doctor visit and associated costs.
  • Additional Surgeries – There are cases when you could need additional surgery. If there should be serious complications, additional surgery may be needed to correct the problem. Some weight loss surgeries are actually designed as multiple techniques performed at a staggered interval. This would involve being operated more than once. Finally, many people see dramatic weight loss which requires cosmetic surgery to remove excess skin that is left over after the weight is gone. All of these surgeries would obviously add to the total cost you end up spending on your bariatric surgery.
  • Insurance & Financing – Insurance can potentially cover your bariatric surgery but they may not cover every portion and all of the follow up care. Or your surgeon may offer financing that involves interest on your payments. Both of these scenarios involve costs that could increase the price.

Questions You Can Expect Your Doctor To Ask

When you meet with your doctor to consult about your weight loss surgery, your doctor is going to make absolutely sure that you understand everything that is involved with weight loss surgery. That includes the physical as well as mental and emotional hurdles you are going to face. Bariatric surgery is a dramatic life change that can be too much to handle for some people so your doctor will ask a series of questions to determine if you are capable of handling everything that comes along with your bariatric surgery.

Some of the questions you can expect are:

  • Are you aware of the risks? You need to understand that all forms of bariatric surgery have risks and there is no risk free method you can choose. Those risks range from the short term and minor to the long term and potentially fatal. This will be one of the first questions you should expect as it is critical that you understand the risks of surgery ahead of time.
  • Do you have realistic expectations for the surgery? Your doctor is going to want to know that you understand what the realistic expectations are for your surgery. If you have expectations that are beyond the standard results you may be setting yourself up for disappointment if you don’t meet those unrealistic expectations. You should have a clear understanding of what success means and how to achieve it before undergoing surgery.
  • Are you ready to commit to losing weight? Surgery is just the first step towards losing weight. After bariatric surgery you will still have a lot of work to do to lose weight but most importantly keep the weight off. Your doctor is going to want to be sure that you are committed to a lifestyle overhaul that includes a new diet and a commitment to regular exercise. It’s all of these things in conjunction that leads to long term success. The surgery alone will not be enough, you and you alone are the ultimate deciding factor in how much weight you lose.
  • Do you know what foods to avoid and which to eat? Your diet will have to change after your surgery for a couple of reasons. First, with many bariatric surgeries, the amount of food you can physically take in will be greatly diminished. This will take some time getting comfortable with. If you try and eat to much you can actually do physical damage to yourself which could lead to additional surgery.

Secondly, you will have to learn which foods to focus on and stay away from to ensure you are getting as many vitamins and nutrients as possible in the limited amount of food you are able to take in. Many patients need to supplement their diet with multivitamins to ensure they are not depriving themselves of basic nutritional requirements.
Are you prepared to seek help/support?Surgery is a very difficult event and seeking out help and support is vital to maintaining a healthy state of mind and perspective. Many patients seek out a mental health counselor to discuss their issues, thoughts and feelings while many others join support groups made up of other people who have also gone through similar procedures.

Types of support can include:

  • Mental health professionals
  • Local weight loss support groups
  • Online weight loss communities
  • Friends & Family

It’s this type of support that is extremely beneficial, especially during those periods where times are tougher and you need someone to lean on for words of encouragement or simply a pat on the back. Your doctor will want to know that you are prepared to take these steps or have even already looked in to groups you can join once you’ve had your surgery.

Take some time and really think about the questions above and how you will answer when your doctor asks you each of these questions. Research as much as you can and learn everything you need to know ahead of time so that you are completely sure that bariatric surgery makes sense for you. You need to be honest with yourself and your doctor before you can begin the journey of weight loss surgery and a total life transformation.

Who is a Candidate for Bariatric Surgery?

Bariatric surgery is not for everyone. Even though it offers great potential, with that comes great risk. Bariatric surgery is a major medical procedure and surgeons must first be sure that patients are good candidates before moving forward with the surgery. The screening process for bariatric surgery is extensive and requires a lot of testing, both physically and mentally to be sure that the patient is indeed well prepared. Candidates are typically between the ages of 18 and 65, although some people younger may be eligible depending on conditions.

Primary Requirements

Here’s the primary criteria for potential weight loss surgery patients:

  • Have you made serious efforts to lose weight through healthy diet and exercise and been unsuccessful? Be prepared to discuss what you’ve tried with your doctor.
  • Is your Body Mass Index (BMI) greater than 40? Over 40 is considered extremely obese and could qualify you for surgical intervention.
  • Is your Body Mass Index below 40 but above 30 and you have a health problem related to your weight? Certain people can qualify if they have a weight-related medical condition but do not meet the BMI of 40 that is typically required for weight loss surgery.

Some of the typical obesity related conditions include:

  • High blood pressure
  • Diabetes
  • Arthritis
  • Sleep apnea
  • High cholesterol
  • Family history of heart disease
  • Obesity hypoventilation
  • Asthma
  • Disabling pain in your joints

Additional Factors Considered

If you’ve met the basic requirements above you will then need to meet with your doctor to review all of the potential risks and complications that can arise. Surgeons need to know patients can handle these risks and have well-managed expectations for how life will change following bariatric surgery in order to proceed with treatment.

Your doctor will evaluate you in the following areas

  • Your nutrition history and your weight level over time
  • Your overall medical condition. You may need to have a weight related medical condition to qualify for surgery but certain medical conditions can be made worse by having the surgery. It will be up to your doctor to make the determination on a case by case basis.
  • Your mental state. Patients will be evaluated to ensure that they are mentally prepared for all of the changes that will take place after the surgery. It will take a sound mind to be able to understand all of the changes and be able to properly stick to the necessary diet and exercise regimen that will come along with this surgery.
  • How long have you been obese? If you have been obese with a BMI near or over 40 for 5 years or more, your doctor may be more inclined to recommend surgery than if you have been obese for a shorter time frame. This is because your doctor wants to ensure you have tried all other methods of weight loss first before undergoing surgery.

Once you meet the established criteria for all patients, your doctor will look to assess you personally by asking you a series of questions. These questions from your doctor are intended to ensure that you are truly ready for all that comes along with weight loss surgery and are fully committed to everything you will need to do in order to make it successful.

Weight Loss Surgery Comparison

The image below is a graphic representation of the similarities and differences between three of the most popular weight loss surgery options. While there are other options you can select, gastric bypass, gastric sleeve surgery and gastric banding are three of the most common choices today.

These surgeries have their own individual strengths and weaknesses that you should take in to consideration when selecting the bariatric surgery option that is best for you.

 

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What is Bariatric Surgery?

Bariatric surgery refers to a range of surgical procedures designed to help severely obese people lose weight. With some 15 million people in the United States suffering from severe obesity, the number of bariatric procedures has risen exponentially over the last two decades. According to the American Society for Metabolic and Bariatric Surgery, 220,000 people had bariatric surgery in 2009, compared to 18,000 procedures performed in the early 1990s.

These procedures can be categorized according to their modes of action. Some limit food intake, generally by decreasing the size of the stomach so that patients feel sated sooner than they did before surgery. Others restrict the body’s ability to absorb some components of food, including calories. A third category incorporates aspects of both methods.

Types of Surgery

While there are a variety of bariatric surgery options to choose from, some surgeries lose favor over time and others become more popular as technology changes and as studies are done measuring the long term success rates. The three surgery options below are more commonly performed today due to their effectiveness and overall patient outcome.

  • Vertical Sleeve Gastrectomy: The stomach is divided along its vertical access and stapled, reducing its volume by up to 85 percent.
  • Laparoscopic Adjustable Gastric Banding: The stomach is wrapped with a saline-filled silicone band in order to decrease its volume, and the surgeon can adjust the degree of restriction after surgery by changing the amount of saline in the band. This procedure and the Vertical Sleeve Gastrectomy are the purest examples of methods that work by limiting food intake.
  • Gastric Bypass: Perhaps the best-known bariatric surgery, a gastric bypass dramatically reduces the size of the stomach. It also relocates the stomach’s connection to the small intestine so that the duodenum and jejunum are “bypassed,” a change that reduces calorie absorption.

Bariatric surgery is performed both as a traditional open procedure and as a laparoscopic procedure in which small instruments and a miniature camera are inserted through a single abdominal incision. Laparoscopic surgery can offer a faster and less painful recovery than the traditional approach.

Surgical Criteria

The criteria for bariatric surgery generally revolve around an individual’s body mass index (BMI), a number obtained by dividing body weight by the square of a person’s height.

According to the National Institutes of Health, bariatric surgery is appropriate for patients with a BMI of 40 or greater and for patients with a BMI of at least 35 if there are additional obesity-related medical problems like diabetes, serious sleep apnea or hypertension. Recent research, however, has shown support for bariatric surgery when patients who are otherwise healthy have a BMI of at least 35 and when patients with additional medical issues have a BMI of at least 30.

Benefits and Risks

Regardless of the specific procedure, all types of bariatric surgery have been effective in achieving weight loss, with the majority of that loss occurring within two years of surgery. The purely restrictive procedures, like Vertical Sleeve Gastrectomy and Gastric Banding, tend to result in losses that are less dramatic than those obtained with combined procedures, but even those purely restrictive procedures result in losses that average 50 percent of excess weight.

Weight loss is only one of the surgery’s potential benefits. Almost all diabetic patients experience a significant improvement of the disease, with many obtaining a complete resolution. In more than 85 percent of patients, sleep apnea is resolved by surgery. Life expectancy increases by some 89 percent, the risk of developing heart disease is cut in half, and the risk of premature death is reduced by up to 40 percent.

Bariatric surgery is major surgery, done on an inpatient basis and requiring a hospital stay of up to two days, and, as such, it carries some degree of risk. Most of those risks are identical to those inherent in any major surgery, including infection and incisional hernia, but the medical consensus is that the benefits of bariatric surgery outweigh its risks. According to the federal government’s Agency for Healthcare Research and Quality, the risk of death is 0.1 percent and the risk of major complications is approximately four percent.

Patients should be aware that procedures that reduce absorption can result in deficiencies in vitamins and minerals, including calcium, iron and fat-soluble vitamins.

Costs

The cost of bariatric surgery ranges from $10,000 to $35,000, depending on the procedure and the patient’s location. Insurance coverage varies among insurers and among specific policy provisions.
Read more here about the cost of bariatric surgery.

Weight Loss Surgery Basics

There is a lot of information surrounding weight loss surgery that you need to know before, after and during the procedure. By having all the information you can gather ahead of time, the better prepared you can be and the amount of questions or surprises you come across will be reduced.

In preparation for your bariatric surgery you will need to understand what the pre-op procedures consist of including what tests and consultations you should expect. After your surgery you should be prepared for a new diet, a consistent exercise routine and a drastic change in your body rather quickly.

Types of Bariatric Surgery

There are a number of different bariatric surgery procedures and how they go about helping you achieve weight loss. Each one has its own advantages and disadvantages. Depending on your specific situation and needs your choice in procedure may differ from someone else and what meets their needs. Your doctor can review your situation and the options with you to determine the best route for you to take.

Restrictive Bariatric Surgery Procedures

Restrictive bariatric surgery works by physically reducing the size of the stomach and lowering the amount of food that you are able to take in. Food intake is restricted by creating a small pouch at the top of the stomach where the food enters. This pouch can initially hold about 1 ounce of food but can expand to hold up to 2-3 ounces over time. The pouch’s outlet usually has a total diameter of about 1/4 inch. This small outlet delays the emptying of food from the stomach and causes a feeling of fullness so you eat less.

Weight Loss Surgeries that are restrictive in method are:

  • Gastric Banding
  • Gastric Sleeve
  • Vertical Banded Gastroplasty
  • Gastric Plication

Malabsorptive Bariatric Surgery Procedures

Malabsorptive weight loss surgery works by helping patients lose weight by decreasing the amount of nutrition (calories) the body is able to absorb through the intestinal tract. This is accomplished by bypassing a portion of the small intestine so that it cannot access digested food, decreasing the calories the body can use. This type of surgery does not limit the amount of food that can be taken in.

Weight Loss Surgeries that are malabsorptive in method are:

  • Biliopancreatic Diversion

Hybrid (Combination) Bariatric Surgery Procedures

Hybrid or combination weight loss surgeries combine the techniques of both a restrictive procedure and a malabsorptive procedure in to one. The thought is that both reducing the amount of food intake as well as the ability to absorb that food will help to give a two phased approach to weight loss.

Weight Loss Surgeries that are a combination of restrictive and malabsorptive in method are:

  • Gastric Bypass
  • Duodenal Switch