Obesity represents a serious problem for millions of people around the world. There are various ways of coping with this issue, including exercising, diets, medications, and surgical operations. Lots of patients opt for a surgery as they see it as a fast and efficient solution. But, instant solutions are not always great; it has long-term health issues.
However, weight loss surgeries, like all kinds of surgical procedures, carry certain risks. Let’s learn more about weight loss surgeries and risks associated with these kinds of procedures.
What is a weight loss surgery?
Weight loss surgeries, also called bariatric surgeries, treat extreme obesity by reducing the volume of the stomach. It is a surgical procedure done in obese patients with aim of obtaining a significant weight loss. It is based on two main principles:
- Restriction of the stomach capacity
- Reduction of calorie absorption ability (1).
Different models, different approaches to weight loss surgeries are currently being performed and tested around the world. There are five main types of weight loss surgeries today. Those are:
1. Electrical pacemaker implant surgery
In this procedure, the surgeon installs a pacemaker under the skin and fastens the electrode to the wall of the stomach. When the patient starts taking the food and the stomach starts to get full, the remote neurostimulation begins, so that the stomach emptying process is slower than the usual. This way, the feeling of satiety arises more quickly. The patient feels the need to eat smaller portions of food (2). After some time, the patient starts losing weight as a consequence of eating significantly smaller portions of food.
2. Duodenal switch
This weight loss surgical procedure implies removing a significantly large portion of the stomach. The first part of the small intestine which is called the duodenum is left untouched, as well as the valve releasing the food into it. The middle parts of the intestines are removed, while the last part is attached to the duodenum directly and this is why the procedure is called the duodenal switch.
This is a complicated procedure as the middle, removed part of the intestines has to be attached to the final segment of the intestines. This allows flowing of the digestive juices. This procedure is based on the idea of limiting the calorie intake and creating a smaller stomach capacity (1).
3. Gastric Banding
This procedure implies banding the stomach entrance in order to narrow it down to 8-14 mm opening. This is achieved with the help of an elastic silicone tape. This way, the upper part of the stomach is formed and segmented. It becomes full soon after you start eating (3).
4. Sleeve gastrectomy – Removal of a large portion of the stomach
This type of intervention is very common. The stomach reduction or the sleeve gastrectomy procedure lasts about an hour and a half. The surgeon removes most of the stomach during the surgery. The remaining part of the stomach is closed with stitches and buckles. This surgery is based on the idea that the remaining part of the stomach produces much less ghrelin, the appetite hormone, as well as the obvious, radical stomach reduction technique (4).
5. Gastric bypass
This operation is the most popular weight loss surgery type performed worldwide. It reduces the inflow of food and its absorption in the intestines. It is based on creating a pouch at the stomach top. The small intestines are then connected to this pouch, creating a bypass. This procedure provides a more significant weight loss than any other surgical weight loss procedure (1).
However, we will now see the risks of this, and the other 4 described procedures.
The risks of weight loss surgeries
Even though these kinds of procedures are seen as relatively safe, the postoperative complications of weight loss surgeries are not very rare. It is true that the patient cannot eat large amounts of food after the operation and that his/her appetite significantly decreases.
The patient gradually but steadily loses weight. On average, patients lose between 2 and 7 kilograms per month. This weight loss process lasts until the patient reaches the weight that is three percent higher than the ideal one.
However, there are certain risks associated with these procedures that cannot be neglected nor underestimated. Large surgical procedures always carry a risk of bleeding in the abdominal cavity.
Weight loss surgeries may lead to inadequate nutrition and digestive disorders. Sometimes, post-operative surgeries in the abdominal cavity are also required as the first treatment might need a correction.
Patients often can’t get used to the new way of life they have to lead after the surgery. Anyone who has had a weight loss surgery must be under medical supervision until the end of his/her life.
One of the dangers associated with the gastric balloon surgery, which is nowadays not performed so often anymore, is cracking of the balloon which leads to the toxins entering the bloodstream. This is one of the fatal consequences of this type of weight loss surgery. Statistics say that every tenth such operation is accompanied by significant problems and there are at least 12 recorded deaths in the past year in the UK (5).
According to statistics, weight loss surgeries, in general, carry the following risks:
- The possibility of the stomach tissue perforation
- The gastric band can slip
- The upper part of the stomach can get enlarged
- Can lead to a lack of iron and calcium
- Diarrhea (6).
Long-term side effects of having a weight loss surgery
There are some long-term side effects related to each type of weight loss surgery. We classified them as long-term because some of them cannot be reversed without removing the pacemaker or the neurostimulator, while the others can never be reversed.
The risks and complications associated with the electrical pacemaker weight loss surgery include:
- implant location pain,
- repeated infections,
- lead penetration,
- stomach wall perforation,
- persistent irritation,
- tissue damage,
- lead obstruction of intestines (3).
Furthermore, the long-term risks associated with the electrical pacemaker or the neurostimulator implants imply the inability to undergo several types of procedures, treatments, and scanners later in your life.
Let’s start with the basic ones. Some electrical equipment, including scanners for theft detection and security screening, can detect your pacemaker.
Furthermore, more serious consequences are related to medical conditions. Those who have had the electrical pacemaker surgery cannot have the diathermy treatment. Diathermy is a medical procedure which is used to stimulate circulation and warm up certain parts of the human body. Therefore, it can be a very important procedure in some medical conditions.
In addition, patients who had undergone the electrical pacemaker surgery cannot go through the MRI scan. Also, this type of procedure is not suitable for patients with anesthesia-related issues or any kind of mental conditions (7).
Gastric banding also carries some important risks. The band often shifts and gets weaker. Approximately every seventh patient has to go through another surgical procedure which would adjust the band. In the United States, this kind of operation is often performed, while European specialists avoid it for several years. In the past two years, this approach lost its relevance.
Other common problems patients experience after gastric banding surgery are:
- Too tight band – health issues
- Too lose band – no results
- Wound infections
- Minor bleeding (3).
Gastric bypass surgery lifetime side-effects include poor vitamin and other nutrient absorption. This is why patients must take vitamin and mineral supplements their whole life.
Even though the mortality rates reported after weight loss surgeries during the procedure themselves are rather low, the mortality rates after the patient discharge are significant. Some studies argue that two leading suspected reasons for high post-discharge mortality rates in weight loss surgery patients include the arrhythmia and pulmonary emboli. However, such studies have not yet been proven.
Lethal complications of weight loss surgeries
There are various complications after bariatric surgical procedures that can be lethal. Specialists found two main groups of complications:
- The acute lethal complications
- Long-term complications that can be lethal.
The acute forms occur in 5–10% of the bariatric surgical patients. The percentage depends on the kind of procedure, as well as various risks associated with patient disease history, anamneses, and patient risk, including age, and general health condition. These acute risks include:
- anastomotic leaks,
As previously stated, experts say that the two most severe kinds of complications involve arrhythmias and pulmonary emboli (8).
The long-term complications of bariatric surgeries, in general, are usually related to nutritional deficiencies. This is especially true for gastric bypass surgeries, as they are partly based on diminished calorie absorption. Unfortunately, this system does not spare the vitamin and mineral absorption either.
Furthermore, internal hernias are not rare. These conditions are described as protrusions of intestines through defects which occur as consequences of bariatric surgery (9).
These patients often suffer from emotional disorders (10). Psychiatrists and psychologists are still conducting various important studies on the emotional effects of bariatric surgeries.
Patients who had undergone weight loss surgeries have to be ready to change their lifestyle. This varies from rather basic things, such as restraining from activities that exert stress on the treated zone, such as sudden bending, stretching or bouncing (11), to severe nutrition habits changes.
Even though nutritional deficits can be somewhat amortized with a proper and consistent daily intake of nutrients, namely multivitamins, minerals, as well as iron for women who did not reach their menopause yet, some nutrition-related disorders still occur in these patients. Those include:
Today, these are all usually rare illnesses under normal circumstances and are all related to dietary deficiencies (8).
Weight loss surgeries carry lots of health-related risks. The treatments of some of these complications are very successful, but require a prompt, timely, and adequate recognition and response by a professional. Furthermore, some of the acute conditions quickly become chronic if not treated and can become a life-long issue the patient has to deal with. Such cases require constant care.
Therefore, it is crucial to get to know all kinds of weight loss surgery terms, conditions, and risks before undergoing one.
(1) Mayo Clinic Staff. Guide to types of weight-loss surgery. Published online on: May 27, 2016. Found online at: //www.mayoclinic.org/tests-procedures/gastric-bypass-surgery/in-depth/weight-loss-surgery/art-20045334
(2) Health care specialists at UCSF Medical Center. Gastric Electrical Stimulation. Published online on: n.d. Found online at: //www.ucsfhealth.org/treatments/gastric_electrical_stimulation/
(3) What Is Gastric Banding Surgery for Weight Loss? Found online at: //www.webmd.com/diet/obesity/gastric-banding-surgery-for-weight-loss#1
(4) Bužga M, Zavadilova V, Holeczy P, Zdenek Š, Švorc P, Foltys A, Zonča P. Dietary intake and ghrelin and leptin changes after sleeve gastrectomy. WideochirInne Tech Maloinwazyjne. 2014 Dec; 9(4): 554–561. Published online 2014 Sep 23. doi: [10.5114/wiitm.2014.45437] Found online at: //www.ncbi.nlm.nih.gov/pmc/articles/PMC4280419/
(5) De Graaf M. Five more dead after having gastric balloons inserted to treat obesity – bringing death toll to 12, FDA reveals. Published online on: 5 June 2018. Found online at: //www.dailymail.co.uk/health/article-5808847/Five-killed-gastric-balloons-inserted-treat-obesity-FDA-reveals.html
(6) WebMd. Is Weight Loss Surgery Right for You? Published online on: n.d. Found online at: //www.webmd.com/diet/obesity/surgery-for-you#2
(7) Medtronic. Is gastric electrical stimulation right for you? Enterra therapy. Found online at: //www.medtronic.com/us-en/patients/treatments-therapies/neurostimulator-gastroparesis/getting-therapy/right-for-you.html
(8) Pories W J. Bariatric Surgery: Risks and Rewards. J ClinEndocrinolMetab. 2008 Nov; 93(11 Suppl 1): S89–S96. doi: [10.1210/jc.2008-1641] Available online at: //www.ncbi.nlm.nih.gov/pmc/articles/PMC2729256/
(9) Jeansonne L O, Morgenthal C B, White B C, Lin E. Internal Hernia after Laparoscopic Gastric Bypass: A Review of the Literature. Published online on: April 26 2007. Found online at: //bariatrictimes.com/internal-hernia-after-laparoscopic-gastric-bypass-a-review-of-the-literature/
(10) Jiang W, Gagliardi J P, Pritham Raj Y, Silvertooth E J, Christopher E J, Krishnan K R R. Acute Psychotic Disorder After Gastric Bypass Surgery: Differential Diagnosis and Treatment. Clinical Case Conference. Published online on: n.d. Found online at: //ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.163.1.15
(11) Medtronic. Important safety information. Found online at: //www.medtronic.com/us-en/patients/treatments-therapies/neurostimulator-gastroparesis/important-safety-information.html
Rakib Sarwar, B Pharm, is a certified pharmacist who has more than six years of professional experience in pharmaceutical marketing. He has accomplished his Bachelor of Pharmacy, from The Khulna University in Bangladesh. In his lifetime, he has gained vast experience which he generously uses to improve the livelihoods of the people he serves from day to day.
Currently, Rakib Sarwar is working in Delta Pharma Ltd. He has been working with this reputed pharmaceutical organization since early 2011. Here he is responsible for the promotion of drugs and medical products, including visits to gastroenterologists, pediatricians, gynecologists and pharmacies, KOLs (heads of departments in hospitals and private sector); organizing all local events (group presentations, lectures, workshops) for Health centers and pharmacy chains, designing sales strategies, finding key customers, product positioning and preparation of promotional materials; organization, preparation and participation in international congresses, accompanied by a group of physicians; realization of Commercial activities in pharmacies, managing marketing budget; monitoring sales results, data analysis, and action planning; and monitoring competition by gathering current marketplace information on pricing, products, new products, delivery schedules, and more.