Summary of Major Risks Associated with Roux en-Y Gastric Bypass

Roux-en-Y Gastric Bypass is a major operation that carries substantial risks. In making the decision to have this procedure done, it is critically important that patients understand the risks associated with the operation. The benefit of weight loss surgery is to enable the patient to have a tool to help with diet. Appropriate dietary intake with exercise will greatly improve results of the weight loss procedure. Alternatives to this procedure is dietary guidance with psychotherapy, diet and medication, using appetite suppressants, and finally all of these programs will require an increase in physical activity.

Weight reduction surgery has been reported to improve several co-morbid conditions such as:

• Glucose intolerance and frank diabetes mellitus
• Sleep apnea and obesity associated hypoventilation
• Hypertension
• Serum lipid abnormalities
• Osteoarthritis

At the time a decision is made to have the surgery, you will be asked to sign a consent form stating you understand all the risks involved. You are encouraged to ask questions at the time of your consult regarding any or all risks involved. Please read carefully; discuss these risks with your family, friends or other medical professionals. The risks are as follows:

1) BLEEDING
With any major surgery, bleeding can occur. If sufficient blood volume is lost, a transfusion might be necessary. There is approximately a 1 in 500,000 risk of contracting AIDS or hepatitis from blood transfusion. Many patients desire to bank their own blood in anticipation for the need of a transfusion. The risk is somewhat higher in revisional operations than in first time cases. There also can be bleeding from ulcers that can develop in the pouch following surgery.

2) SPLENECTOMY
The spleen is a very fragile organ that lies immediately adjacent to the operative field. It is easily injured and if sufficiently damaged it may need to be removed. It serves as a filter for the blood, as well as an immune organ. Patients without spleens generally do quite well, but have increased susceptibility to certain kinds of infections throughout their lifetime.

3) ANEMIA
After the gastric bypass operation, anemia is inevitable. The stomach is required for the normal absorption of iron and vitamin B-12. Because of this, it is absolutely essential patients undergoing bariatric surgery have life-long medical follow-up. For patients undergoing the gastric bypass operation, it is essential that they take supplemental iron and vitamin B-12 shots. Generally, chewable vitamins with iron are sufficient for the iron requirement and 1000 micrograms/day of vitamin B-12 are necessary. Most patients require periodic injections of vitamin B-12 to supplement the oral intake. These injections need to be administered every 1-3 months.

4) BOWEL OBSTRUCTION
Any abdominal surgery has the risk of causing bowel obstructions (intestinal obstructions). This can occur any time in the future and it is caused by scar tissue formation inside the abdomen.

Scarring can form around the loops of the bowel, obstructing them. This results in pain, nausea and vomiting. It is possible that additional hospitalization or surgeries might be necessary.

5) HERNIA
Patients are at risk of developing a post-operative hernia. These hernias can occur through the incision, or an internal hernia may form. Patients may be at risk of developing an incisional hernia if they undergo an open procedure. Laparoscopic and open patients may develop an internal hernia with a bowel obstruction caused by scar tissues.

6) CHRONIC DIARRHEA
Unlike intestinal bypass operations, malabsorption with resulting diarrhea is not a feature of the gastroplasty or gastric bypass operation. However, there is an occasional patient who experiences chronic diarrhea lasting a year or more after surgery.

7) DUMPING SYNDROME
This is associated with the gastric bypass operation and patients will have abdominal pain, cramping, nausea, diarrhea, heart palpitations, dizziness, loss of consciousness, etc., when sugars and carbohydrates are ingested. Patients rapidly develop an aversion for these substances. Symptoms can be quite bothersome in the first few months after surgery, but generally are fairly minor after that time.

8) CHRONIC NAUSEA AND VOMITING
Any time the stomach is operated on, nausea will develop. Nausea can be significant for several days after surgery and it has been known to be present for several months after the operation. Vomiting is a main component of banded gastroplasties and is experienced by virtually all patients who have these operations. On the other hand, vomiting is unusual in gastric bypass patients. Some vomiting is experienced as new diets are tried the first several months after surgery, but it is unusual after that period of time. There is an occasional patient who has problems with vomiting beyond this period of time.

9) ABSCESS
An abscess is an infection inside the abdominal cavity. When this occurs, additional operations are often required to drain the infection.

10) WOUND INFECTION
Because the abdominal wall fat tissue heals slowly, it tends to become infected. These infections are self-limited and are easily treated by opening up the skin incision and allowing the wound to heal from the bottom up.

11) PNEUMONIA
Because obese patients have limited respiratory movements, they are susceptible to development of pneumonia immediately after abdominal surgery.

12) DEEP VENOUS THROMBOSIS
Obese patients have poor blood flow in their legs. When these patients undergo surgery of any type, blood tends to pool in the legs and clot. These clots can restrict the venous drainage from the leg resulting in significant leg swelling. This can become severe and could require treatment with chronic blood thinners.

13) PULMONARY EMBOLUS
When a blood clot from the leg breaks lose and travels to the lung, it is called a pulmonary embolus. Like a deep venous thrombosis, it is a risk of surgery of any type in the obese. Special precautions are taken in the operation room to avoid the development of deep venous thrombosis of pulmonary emboli. All patients are required to stop estrogen replacement therapy one month before surgery and to stay off of estrogen replacement for at least two months after surgery.

14) MYOCARDIAL INFARCTION AND STROKE
The process of being put to sleep and waking up can result in a heart attack or stroke. Although this can happen, it is extremely rare.

15) CALCIUM DEFICIENCY
It has been reported that calcium absorption is limited after gastric bypass surgery. This can result in bone loss or osteoporosis with resultant fractures. We recommend supplemental calcium after gastric bypass to avoid the development of osteoporosis.

16) IREVERSABILITY
The Roux en-Y Gastric Bypass operation is permanent. There is no need to reverse it once weight loss is achieved. If for some reason you desire reversal, it is important recognize that the stomach’s function may not return to normal. Surgical manipulation of the stomach induces permanent alterations eating habits.

17) HAIR LOSS
Some patients will experience some thinning of the hair during the first six months after surgery. This is due to lack of protein supplements in their diet. This will usually reverse itself after 6 months.

18) CIGARETTE SMOKING
Patients who smoke are a high risk for surgery. Complications associated with smoking are: Pneumonia, poor wound healing, pulmonary embolism and death. Patients are urged to discontinue smoking 3 months prior to surgery.

19) ANASTOMOTIC LEAK
The anastomosis is where the bowels are connected together during the surgery. There is a risk that leakage of intestinal contents at this location that can result in serious complications. The most severe is infection and the inability to eat for many months.

20) MARGINAL ULCERATION
There are ulcers that occur in the small intestine of in the pouch following obesity surgery. They can cause pain and bleeding. Medications or revisional surgery may be required if this complication occurs.

21) DEATH
Your surgeon will discuss the incidence of this surgical risk with you during your consultation visit.