General Complications which can occur after Bariatric Metabolic Surgery

  • Reflux
    • In LAGB patients this symptom +/- regurgitation of food arises when the outlet from the small pouch above the band is too tight causing ingested food or liquid to spill back up into the oeosphagus. If a lapband patient doesn’t follow the “eating with a band rule” then this may exacerbate things. This can also be prevented by ensuring that patients allow at least 1-2 hours from their last meal/drink before then lying down/going to bed. The reflux symptoms can also be alleviated by having some fluid removed from the LAGB.
    • Reflux symptoms occur in approximately 25% of LSG patients because of the pressure generated within the narrow “tube like” stomach. This is often managed with medication, however in a small percentage of patients, further keyhole surgery is required to better manage these symptoms (eg sleeve gastrectomy gets converted to the gastric bypass operation)
    • Reflux symptoms in gastric bypass patient may be as a result of an ulcer at the anastomosis (seam/join) and needs to be investigated by a gastroscopy, and managed accordingly.

      Gastroesophageal Reflus Disease

  • Nutrient deficiency
    • These deficiencies usually occur because of an imbalanced diet due to the small amount of food consumed or certain foods that individuals avoid for a number of different reasons.
    • These deficiencies can sometimes take 3-5 years (sometimes closer to 10 years) to develop, hence vigilance by regular monitoring via blood tets is
    • In LABG patients it is likely to occur if there are certain food intolerances eg low iron if red meat intake is modest
    • In patients who have undergone resection bariatric metabolic surgery, more extensive monitoring and supplementation is required, specific to the operation performed eg vitamin B1, vitamin B12, iron, calcium, vitamin D, iron; fat soluble vitamins in some cases eg OAGB, BPD, SADI
  • Gallstones
    • Approximately 1% of the community has gallstones; having overweight or obesity is a risk factor in itself for an individual to developgallstones.
    • If you already know that you have gallstones, please notify the Clinic as it may affect your treatment options eg consideration of the gallbladder to be removed at the time of surgery (where applicable)
    • The science shows us that losing weight by any means, whether this is medically-induced and/ or bariatric surgically-induced, increases the risk of developing gallstones (2% to 3-4% respectively)
    • Removal of the gallbladder containing the gallstones is usually performed via laparoscopic keyhole surgery, so as to avoid the uncommon complications of gallstone-induced hepatitis or pancreatitis.

      Gallstones

  • Herniation in the incision site
    • Sometimes a hernia can form along the skin scar line. A hernia is basically a weakness in the abdominal wall. It can often be prevented by avoiding heavy lifting in the first few months after your operation. However, if you do develop a hernia, it may need to be corrected by surgery.

      Herniation in the incision site

  • Loose redundant skin
    • If an individual loses a lot of weight, they may develop loose redundant skin. It usually occurs in the arms, breasts, abdomen and thighs. Exercise during the weight loss phase may help reduce the amount of loose skin and help tone up the body, especially in younger individuals with a lot of elastin in their skin. However the response to excersie with respect to “toning up” is variable and partly genetic.
    • Please note however, that some loose skin is to be expected
    • Excessive skin folds can become a problem, especially in summer. Rashes and other skin conditions eg boils, folliculitis etc can be concerning, especially under the breasts and abdomen.
    • Approximately 20% of patients who have lost a significant amount of weight, go on to have plastic surgery to remove the redundant skin.
  • Acid erosion of teeth
    • The teeth’s enamel surface is made up of calcium amongst other minerals, and are susceptible to acid attack. If the fluid around the teeth changes eg poor cleaning technique, stomach acid from reflux/ regurgitation, regular sugar ingestion etc, the calcium will dissolve from the tooth, resulting in tooth decay.
    • This can be prevented with good dental hygiene ie after every main meal
    • If you are experiencing symptoms of reflux please let your GP or our Clinic know ASAP

      cid erosion of teeth

  • Hair thinning
    • Can occur after medically-induced or surgically-induced weight loss
    • Tends to occur during the rapid weight loss phase,perhaps with a lag of 2-3 months
    • Given the lifecycle of hairs, you should anticipate some improvement within 3-6 months
  • Metabolic bone disease
    • Due to malabsorption of calcium and other reasons
    • Baseline DEXA scan and regular monitoring is necessary
    • Calcium citrate and vitamin D supplementation is recommended
    • Weight bearing and resistance exercises to help preserve lean body mass is also recommended

      Metabolic Bone Disease

  • Some weight regain
    • I understand this is frustrating, but it needs to be understood that this is normal and to be expected
    • Reasons for this are many, and not entirely understood, however include the body “readjusting”

      Some weight regain

General Risks associated with Laparoscopic (keyhole) Surgery include:

  • Excessive bleeding
  • Infection
  • Injury to the surrounding organs
  • Injury to the stomach wall
  • Injury to major blood vessels
  • Gas embolus from the gas used in the abdominal activity to allow the operation to be keyhole
  • Converting the laparoscopic (keyhole) operation to an open approach. Often this is not a complication per se, but rather done to protect the interest of the patient’s safety and wellbeing.
  • A potential complication to an open incision is the possibility of developing an incisional hernia in the long term. The likelihood of this is higher, approximately 1-2% in people with obesity, than in those of a healthier BMI range.
  • The University of New South Wales
  • Obesity Australia
  • ANZMOSS – Australian & New Zealand Metabolic and Obesity Surgery Society
  • Australian and New Zealand Obesity Society
  • Royal Australian College of General Practitioners
  • Care Specialist
  • Strategic  Centre for Obesity Professional Education
  • THE OBESITY COLLECTIVE
  • World Obesity