Bariatric surgery

The list of complications provided represent those most commonly encountered by bariatric surgeons. With surgical practice outliers are possible.

In regards to the issues brought up. Firstly, many patients are misinformed of the procedure they have done. We run a revisional clinic in Edmonton and I get referrals daily about individuals who have had an bypass and are having problems. Many of these especially those who are having the extensive nutritional deficiencies, have not had a Roux en Y bypass but rather an Jejuno-ileal bypass, which as we mention in the article is no longer performed because of these issues. For the Roux en Y with an informed patient, malnutrition should not be an issue.

The wound infection and other issues you mention have changed substantially since the introduction of laparoscopic surgery which has revolutionized bariatric care. The numbers published are those of best evidences based practice.

If we can be of any help to your patients please let us know

SK

I thought that the summary was far to "rose colored" for my patient's experience. I've had patients that have had roux-en-y gastrectomies since nearly 40 years ago. Many of them have been quite ill with comorbid conditions, female and seemingly perfect candidates. Their long term complications include:

Chronic protein/vitamin malnutrition (pt done 40y ago in Edmonton for Obesity) Severe depression (pt done in small hospital program prior to surgery for malignant brain tumor) Late surgical skin infection (severe diabetes with complications, after nearly 2 years of aggressive would care she still has not been able to return to work).

Not one of the above patients would have the surgery again if suggested.

Further, I'd suggest that combined early and late mortality rates compared to the mortality rates of the comorbid illnesses is far higher than the 1-3% quoted here. Also, a fairly large percentage of severely obese patients in my practice do NOT undertake a healthy lifestyle before surgery, although they may claim that they do. Careful inquiry reveals inadequate exercise and excessive empty calories despite multi-disciplinary aggressive counseling. It CAN be a good surgery, but it's nothing like a panacea for severe obesity.

Gallstones post bariatric surgery are a function of the rapidity of weight loss after the procedure has been performed. Patients who lose weight rapidly after bariatric surgery are more at risk of forming gallstones. Gallstones, themselves are not a large issue. The major problem develops if the patient has had a Roux en Y bypass and develops choledocholithiasis, as it is quite difficult to access the common bile duct endoscopically as the anatomy has been re-arranged. The only route to access the CBD is via percutaneous gastrotomy.