Surgical Treatment of Morbid Obesity
Obesity is the #1 nutritional disorder in our nation. In fact, it is one of the major causes of suffering, disability, and death. About 1/5 of Americans are above ideal weight by 30%, a level which is clearly detrimental to health. Dietary measures in persons who are greatly overweight can be succinctly summarized; they rarely work. In 1992, a National Institute of Health study revealed that medically supervised weight loss programs failed 96 to 98% of the time over a five year period. This suggests that statistically, dieting alone will not work for most morbidly obese patients. Thus, surgical treatments are used for extreme obesity.
What Surgery Will Achieve
We consider weight loss of more than 30% of preoperative weight an excellent result. For instance, a person weighing 300 pounds who loses 90 pounds would be considered to have a good weight loss result. We hope and expect about 85%-90% of patients to achieve a good to excellent result. We anticipate that the average patient probably will lose about 30% of the preoperative weight, but there is a great deal of variation with some losing more and some losing less. Thus, a distinct minority of patients will reach a truly normal weight. In fact, such marked weight loss may not be desirable because of baggy skin and other related problems. Successful weight loss corrects or lessens diabetes in almost every patient, and remedies hypertension in over 65% of patients with high blood pressure.
Potential Risks and Complications
Surgery for morbid obesity is considered major surgery and, as with all operations, carries the risk of general anesthesia and potential complications that are more common as weight increases. As part of our education process, it is important for us to describe potential complications to you.
Risks and complications during surgery may include perforation of the stomach or intestine, leak from connections with peritonitis or abscess, internal bleeding, wound infection (including opening of the wound), incisional hernia, injury to the spleen with potential removal of the spleen, and bowel obstruction. Pulmonary embolism (blood clots to your lungs from your legs), pneumonia, atelectasis (collapse of lung tissue), fluid in the chest or other breathing problems may occur. Compression hose and walking after surgery assist decreasing the incidence of blood clots.
With any major surgery, there is the risk of myocardial infarction (heart attack), congestive heart failure, irregular heartbeat, stroke, liver or kidney problems. Although rare (approximately 1%), death may occur as a result of one of the complications of this operation.
Other complications include minor wound or skin infections, urinary tract infection, allergic reactions to medications, excessive vomiting/dehydration, development of loose skin, narrowing or stretching of the anastomosis (the outlet of the stomach), peptic ulcer disease, psychological reactions including depression while adjusting to new eating and lifestyle. Other late problems may include falilure to lose weight or weight regain. Dumping syndrome (fast heartbeat, nausea, vomiting, fainting, diarrhea) may often be described as a side effect of the operation.
Gallbladder disease is not uncommon in association with morbid obesity. The gallbladder may be removed if preoperative studies indicate the need, or if gallbladder disease is noted at surgery. Ulcers at the site of the stomach or intestinal anastomoses (stomal ulcer) or acide peptic ulcers in the nonfunctional large stomach pouch may occur. Stomal ulcers may be caused by smoking, overeating, aspirin or non-steroidal anti-inflammatory drugs. Cortisone use in the postoperative period may also lead to a higher incidence of ulcers.
Anemia may occur after gastric bypass. Close attention must be given to iron deficiency, especially in women of childbearing age. Taking a multivitamin with iron usually prevents this problem. Vitamin B12 supplements may also be necessary to prevent anemia.
While image is improved, this is a major surgery, not a cosmetic procedure. The goal is improved quality of daily living, living healthier, living longer, resolution and/or improvement of medical problems, cure of control of serious associated illness. The benefit of feeling good about yourself with improved confidence and self-esteem may occur, however some patients experience social or emotional upheavals. Emotional crises such as divorce, acute job dissatisfaction, and other problems can occur as a result of all of the changes that occur after the operation. Whether these problems are related to the surgery or weight reduction is unclear, but they have been noted.