Understanding all the risk factors during weight loss surgeries and the issues afterward.
The benefits of weight-loss surgery are significant. Patients can lose as much as 50 percent of their excess weight as soon as six months after surgery, and up to 77 percent of the excess weight in the year following surgery. Post-surgery studies have shown patients have lower incidence of heart attack, stroke and death after bariatric surgery.
But there are a core of risk factors patients need to be prepared for. And about 10 percent of patients will gain all their weight back.
For example, patients of gastric bypass patients, where stomachs are stapled off and some of the small intestine in bypassed, can get a blood clot to the lungs known as a pulmonary embolism. Also, about 2 percent of patients are stricken with a potentially fatal leak from the staples placed in the stomach.
Meanwhile, a poorly placed gastric band - also known as lap bands - can eat into the stomach.
"There are multiple risk factors associated with any type of surgery, and the obese population is a high risk population anyway," said Leena Khaitan, MD, MPH, Bariatric Surgeon, UH Case Medical Center.
Long gone are the bad old says of bariatric surgery, however. As recently as 2005 studies showed that 1 in 50 people who had bariatric surgery died from the procedures. Now, credible medical teams are held to higher standards and their hospitals are certified as Centers of Excellence.
Laparoscopic surgical techniques and minimally invasive surgery in general have significantly reduced some of those risk factors, such as bleeding and infection, Dr. Khaitan said. According to the Agency for Healthcare Research and Quality (AHRQ), thanks to improvements in the safety of bariatric surgery, the risk of death is about 0.1 percent, and major complications are noted in 4 percent of bariatric surgeries.
Twenty years ago, any surgery on obese patients was considered risky. Now "we know that we can undergo these procedures very safely, but we need to take the appropriate precautions," Khaitan said.
"We don't do weight loss surgery on patients that smoke," she explained, noting that people who smoke heal more slowly and have more complications than those who don't.
Beyond that, before undergoing weight loss surgery, patients are thoroughly evaluated, especially to ensure lung and heart function are good and that other medical conditions, such as high blood pressure or diabetes, are under control.
But there are other complications. With gastric bands those challenges include migration of the band (meaning it moves from its original placement) and erosion of the band (meaning it wears into the stomach). These problems, which occur in in 5 to 10 percent of cases, can be managed with post-surgical treatment.
Pneumonia and blood clots in patients following surgery can also be a problem. Khaitan said it's important to get patients up and moving the day of surgery.
"We also have them coughing and deep breathing to minimize any lung complications," she added. Blood thinners also help with clotting.
Some procedures are riskier than others. Recently a study showed that the rarely performed duodenal switch procedure resulted in more weight loss than gastric bypass surgery. However, 62 percent of duodenal switch patients had complications like abdominal pain and vomiting, while many suffered from long-term malnutrition.
Most hospitals that perform bariatric surgeries have special equipment, such as extra-long breathing tubes and other items, that are needed to treat large or obese patients during surgery or after, she said.
For more information, see the American Society for Metabolic Bariatric Surgery's news site.