What are the risks of surgery?

These are risks that are associated with any operation. There is a risk to life with this surgery which will be discussed. More specifically these are some of the recognised risks of surgery: bleeding, splenectomy (removal of the spleen), pain, fever, thrombophlebitis, blood clots, pneumonia, atelectasis, wound problems, infection,  intra-abdominal abscess, leaks, pancreatitis, ventral hernia, small bowel obstruction, vitamin and salt problems, hair loss, depression, mood swings, vomiting, diarrhoea and various neuropathies.

We take many precautions to avoid these complications. You will realise by our team approach and early mobilisation how we try to minimise these risks to you. If you smoke you should stop; this will help before and after surgery.

Operative outcomes and risks:

Obesity in itself is a risk to life and surgery comes at a potential cost. All operations require general anaesthesia. However the risk to life and the disability of obesity makes these risks acceptable.

The risks of surgery can be broken down into:

• Anaesthetic risks. Anaesthesia is very safe; patients do not die “on the table” except in unusual circumstances.
• General risks: any operation will involve cuts or incisions, which can sometimes develop infection and hernias. Other risks include the risks of any surgery in relation to body functions including chest infections, clots, urine retention and infection.
• There is a risk of bleeding and a blood transfusion may be required. Any keyhole or laparoscopic operation can be converted to an open operation. With keyhole surgery damage to other organs such as the bowel or spleen may also occur. If the operation is technically difficult the operative strategy may be changed or the operation abandoned.

Specific risks. The risks from bariatric surgery vary on the operation and how it is performed. These may occur early or late. In any operation where there is a join made or an organ divided there is a risk of leak. This is normally despite a standard technique and runs at about 1%. This can lead to abscess formation and can be life threatening with prolonged hospital stay. In the long term there may be excessive or inadequate weight loss and there may be problems with dehydration and vitamins. There may be inflammation of the stomach or oesophagus. With rapid weight loss there is a risk of gall stone disease requiring later removal of the gall bladder. Rarely liver disease can be exacerbated by the operation, in the long term often liver dysfunction due to fatty infiltration is improved by bariatric surgery. In sleeve gastrectomy there can be a narrowing of the stomach requiring stretching (dilatation). There is also a psychological risk from surgery.

• Mortality rates for sleeve gastrectomy are in the region of 0.5 %

Outcomes of the sleeve gastrectomy in terms of excess weight loss is 66% at three years. Resolution of diabetes usually occurs months after surgery; it is completely resolved in up to 60% of cases. Hyperlipidaemia and hypertension are resolved in about 2/3 of cases. Sleep apnoea is resolved in a similar manner.

Common Post Operative Symptoms:

Dizziness:

It is not unusual that you will feel lightheaded. This is relieved by finding somewhere to sit or lie down. It is important not to panic. The likely reason that this occurs is because you are not drinking as much as previously and this will adjust with time. If this is happening very frequently (a few times a day) you should call us. Remember to aim to drink about 1.5 litres of fluid per day.

Altered Bowel Habit:

After your surgery it would not be unusual to have watery bowel movements. With the reintroduction of solid foods this may change to a more normal bowel movement. It may be useful to be on a fibre  supplement, but a high fluid intake is still necessary.

Vomiting:

A few episodes of vomiting are not unusual in the first few months after surgery. The stomach can only hold small volumes, about 100mls.  Remember to chew and eat slowly taking up to 45 minutes per meal. Stop when you feel full. Vomiting may be because of not enough chewing, eating too quickly or eating the wrong food.

If the vomiting persists; please call us. If you can not hold anything down for more than 8 hours please call us. If there is vomiting on a regular basis this can also cause damage through swelling and blockage.

Nausea:

Any surgery involving the stomach can cause nausea. It may occur as early as day 3 or after 2 weeks at home.  Despite the nausea you should continue to drink water and if possible keep going with 3 small meals per day. Part of this problem is the reason for the massive weight loss. This nausea is rarely associated with vomiting. If there is vomiting especially white frothy saliva that is not unusual. If you start to vomit food you should call as you may need an x-ray dye study.

Anorexia: not feeling hungry

Again this is a side effect of the surgery: a complete lack of appetite. It is important to eat the 3 small meals per day. Please continue to drink.

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