Obesity, a state of excess fat accumulation in subcutaneous and other body parts, is counted as an emerging risk allover the worls. Obesity is generally measured as Body Mass Index (BMI). BMI above 25 is considered as overweight and those above 30 is considered as obese. Morbid obesity is a condition with BMI index above 40. BMI above 35 with comorbidity is also counted as morbid obesity. Cardiac , pulmonary and reproductive disorders are associated with morbid obesity. Obesity can be controlled by diet restriction, life style modification, drugs and exercise. İnappropriate responses to these therapeutic approaches alarms the necessity for surgical interventions. Commonly used procedures are vertical gastric banding, roux-en-Y gastric bypass and deuodenal switch.
General risks
Usually the surgical procedure is done laproscopically. This method allows faster recovery and doesn’t make any profoundable change in appearance, which can occur in conventional methods of surgery. But however in some case, the procedure may have to be converted to open abdomen approach. A wide incison has to be made for safe continuation and completion of surgery. Open surgery will extend the hospital stay of patient. Bariatric surgery can cause dumbing syndrome. And also there is chance of infection at the site of incision, breathing problems, nutritional deficiencies, pulmonary embolism, cardio-vascular diesease and stomal inflation.
Early Risk
Gastro intestinal anastomosis break down: It happens when the laproscopically attached staples in the reattached region breaks down. It creates more complications and some times leads to second surgery.
İntra-abdominal injury: It is common with all surgical procedures. İntra abdominal organs get injured leading to extention of surgical time and hospital stay.
Bleeding: It can occur at any stage of operation before post operative period. Some times, blood transfusion may be needed during surgery.
Morbid obesity may lead to much complications as it is associated with many other conditions.
Cardio-vascular problems associated with morbid obesity can cause complications during surgery.
Pulmonary embolism and deep vein thrombosis can lead to clot in main blood vessels. Lung problems can extend hospital stay of patient as they may need ventillator support.
Late Complications
Gastro-Enterostomy stenosis : Scarring occurs, in some patients, at the attachment region between stomach and bowel causing stenosis at the site. As a result, vomiting occurs during food intake. Chance of infection in the site of attachment will lead to complication. This gastro-enterostomy stenosis needs later correction by an endoscopic dilatation.
Chance of internal hernia are very rare which need to be managed by surgical correction.
Malabsorption of vitamins like B1 B2 B12, iron, nutrients essential for balancing post surgical fitness can occur. as a result life long supplimentation of oral multivitamins especially vitamin B12 is necessary.
Both early and late onset dumping syndrome can occur in the post operative period as a complication. Sometimes dizziness, fatigue, hypoglycemic attacks can precipitate in these patients. So councelling of the patient regarding this is absolutely necessary.
Hair loss can occur due to low post operative protien intake. Strict follow up of the diet and post operative instructions becomes an absolute necessity .
Renal stones are also associated with bariatric surgery very rarely.
Alterd psycho-social interactions are also reported as a out come of this surgical procedure.
Gastric fistulae between the pouch and the body causes chronic bleeding , insufficient weight loss ,nausea and vomiting.
