During your stay you will be cared for by a huge team of people, including the surgeon, anaesthetist, operating theatre staff, ward nursing staff, physiotherapists, dietitians as well as your cardiologist, endocrinologist, and respiratory physician. All of these people are aware of the potential complications of surgery and have the shared focus of preventing problems.
All operations have risks however, and you need to fully understand the consequences of these before having the procedure. Major risks are rare, and occur in less than 2% of patients.
The risks can be broken down into procedure specifc risks and general risks which can occur in any operation. Most adverse effects following the operation are minor and do not affect your recovery or later outcome. We take great care at reducing the likelihood of all risks, and extra measures if there is a specific risk you are more likely to encounter.
General risks you need to be aware of include:
These are usually minor and need some antibiotic tablets for few days.
Cardiac and Respiratory problems
If you have had cardiac problems such as arrhythmias, angina or a previous heart attack you may be at higher risk of cardiac problems during the anaesthetic. We liaise with your cardiologist closely throughout your admission to decrease the chances of any further problems occurring. If you have any preexisting lung problems such as COPD or you have smoked in the past you may be at increased risk during the operation. Major heart and lung complications are extremely rare however.
The risk of bleeding after an operation is very small. It may be increased if you have recently been taking any blood thinning medications. The risk of having any bleeding requiring a repeat operation to fix it is less than 1%.
Deep Vein Thromboisis and Pulmonary Embolism
These complitacions are extremely uncommon since we go to multiple measures during your stay to prevent them. Some people have a genetic tendency to form blood clots, and you should discuss this with the team. It is important to tell us whether you have had a blood clot in the past after another operation.
Specific Risks relating to particular procedures:
Following the links listed below to read about the relevant risks for each weight loss procedure.
- Risks of Laparoscopic Sleeve Gastrectomy
- Risks of Laparoscopic Gastric Bypass
- Risks of Laparoscopic Adjustable Gastric Band
- Risks of Revisional Weight loss surgery
Risks of Laparoscopic Sleeve Gastrectomy
Laparoscopic Sleeve Gastrectomy is generally very safe and performed extremely commonly in Australia. Nevertheless you need to be aware of it’s potential complications. The most concerning few are as follows:
The major risk we worry about after a sleeve gastrectomy is a leak at the staple line. This is extremely rare (occuring in less than 1% of people) after a primary procedure, however it has the potential to cause major problems. Some people whom have been referred to us after a leak have spent months in hospital and have required multiple operations and other procedures. It is critical to be aware of this risk and be aware of the potential consequences before having the operation.
Some people experience more reflux type symptoms following a sleeve gastrectomy. It is extremely important to discuss with us if you have reflux before having the procedure.
This involves a part of the sleeve becoming too tight, often as a result of excessive internal scarring. This is extremely uncommon (occurring in less than 2% of people) however it does often require further interventions, usually an endoscopy to stretch open the stricture. Uncommonly it requires a second operation.
Functional sleeve failure
Occasionally we see people who have had a sleeve gastrectomy and have symptoms of a stricture despite investigations showing no blockage of the sleeve. This can resolve spontaneously however you may require further procedures to resolve your symptoms.
No-one is able to predict who will experience any of these risks. Despite the concern about them there is always something that can be done to help. We have noticed in dealing with all of these risks in the past that all of them mostly get better after converting to a gastric bypass.
We encourage you to ask questions about these risks when you come in to see us for a consultation.
Risks of Laparoscopic Gastric Bypass
Gastric Bypass is becoming a much more commonly performed procedure in Australia. It is also generally very safe but has a different risk profile compared to a Sleeve gastrectomy. The concerning risks are as follows:
As for any procedure involving stapling the stomach there is a chance of a leak. Compared to a sleeve gastrectomy we have noticed that people who have a leak after a gastric bypass generally do not become as sick. You may still require further operations and interventions however it is uncommon that you would stay in hospital for as long.
Stricture at the anastomosis
Where we join the stomach pouch to the small intestine has the potential to become narrow. This most often requires stretching with an endoscope, and uncommonly requires re-operation.
This occurs after you have a very sugary meal. The high load of sugar entering the small intestine can cause you to feel flushed, dizzy and have abdominal cramps. This is usually short lived after a meal and over time it tends to go away.
Since we divide the small bowel and attach it to the stomach, there are certain gaps in your abdominal cavity in which part of the intestine get stuck in, and can get blocked or twisted. We take care to close these gaps however as you lose large amounts of weight they have the potential to open up again, so at any time following a bypass you are at a small risk of developing these hernias. Usually these are fixed with another laparoscopy to put the bowel back in it’s correct position and repair the gap.
Some people experience ulcers where we join the stomach pouch to the small intestine. This is uncommon in most people however much more likely if you are a smoker. This can be relieved by taking anti-acid medication, it is extremely rare that a perforation can result from the ulcer. We ask that you take anti-acid medication for a month following the bypass operation. If you continue to smoke after the operation you will need to take it life-long.
If you ever have abdominal pain after a gastric bypass you need to seek the advice of a surgeon who is accustomed to dealing with specific complications of a gastric bypass operation. We encourage you to ask questions about these risks when you come in to see us for a consultation.
Risks of Laparoscopic Adjustable Gastric Band
Gastric banding is generally very safe since there is no stapling or division of the stomach. It has it’s own risks since we’re introducing foreign material into your abdomen. The most concerning risks include:
Infection of the band or port
This is uncommon however often it requires removing the band.
Despite fixing the band in position with stitches, sometimes the stomach below the band may slip upwards through the band and cause symptoms such as severe reflux, food intolerance, or pain. This requires an operation to reposition the band or removal. In the worst case the stomach may become completely blocked to the point you cannot tolerate anything orally. This requires an emergency operation. It is extremely rare but possible that the stomach can lose it’s blood supply and die, requiring you to have a complete stomach resection and reconstruction.
The small stomach pouch above the band can stretch over time leading to an enlarged pouch. This is detrimental as it gives poor restriction of food and can lead to vomiting and reflux symptoms. To treat pouch dilatation we release fluid from the band for a period of time. This may give the stomach a chance to relax and recover. If the problem persists after this trial, re-operation with re-positioning of the band is often possible.
Like the pouch dilatation, some people after many years can have their oesophagus distend. Unfortunately we have noticed that this is less amenable to just releasing pressure of the band, as the problem almost always returns. It usually requires removing the band and consideration to convert the band to another weight loss procedure such as gastric bypass.
Despite the band being positioned perfectly and having a normal function, some people just can’t tolerate the feelings they get. They can get frequent vomiting and reflux with the band and find eating foods difficult much of the time. Multiple attempts at adjusting the band may not relieve the effect, and ultimately people have the band removed and convert the band to another weight loss procedure.
Erosion of the band
Rarely the band around the top of your stomach can actually erode into the inside of the stomach. Sometimes people experience abdominal pain with this however surprisingly many people have no symptoms. Because the restriction is lost, often people will regain weight if this occurs. An erosion requires the band and port to be remove and the stomach repaired.
Leak of the band or port
Sometimes the band or the port may leak, and multiple adjustments to fill the band have no effect. The band or the the port will need to be replaced.
Occasionally the access port flips over and cannot be adjusted, this requires a simple operation to put it back in the correct position under the skin.
It has been noted worldwide in recent years that a large proportion of people are requiring reoperations relating to their band, and are also experiencing poor quality of life relating to the symptoms of the band.
Much of our work recently has involved converting the band to gastric bypass procedure. In 78% of our conversions we are able to perform this as a single stage procedure. Occasionally due to excessive scarring relating to the band it is safer to remove the band and perform the gastric bypass about 8 weeks later.
Risks of Revisional weight loss surgery
The risks of converting one type of procedure to another are much higher than a primary procedure. This is due to the scarring caused around the stomach from the previous operation. The specific risks relate to the specific procedure you are converting to, however overall the risks of leak are higher. The increased risk is mainly the complications in the short term.
It must also be understood that a revisional weight loss procedure often does not have as good longer term weight loss than primary procedures.
There are certain procedures which may be impossible or deemed unsafe depending on what problems you have had in the past. Revisional weight loss surgery operations ere extremely patient specific and often take slightly longer than primary procedures.