September 2019 - Dr. Atul Peters

What is Bariatric Surgery? Risk, Complications and Side Effects

Bariatric Surgery or weight loss surgery is done to help you lose excess weight by making changes to your digestive system.

Gastric bypass is one of the most common types of bariatric surgeries or weight loss surgeries being performed all over the world. Gastric bypass surgery is also done to reduce your risk of life-threatening weight-related health problems, including:

Type 2 Diabetes Mellitus
Heart disease
High blood pressure
Severe sleep apnea

Gastric bypass and other weight-loss surgeries are typically done only after you’ve tried to lose weight by improving your diet and exercise habits.

In general, gastric bypass and other weight-loss surgeries could be an option for you if:

Your body mass index (BMI) is 40kg/m2 or higher.
Your BMI is 35 to 40 kg/m2 and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea. In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems.

This surgery requires permanent changes to lead a healthier lifestyle, and long-term follow-up plans that include monitoring your nutrition, your lifestyle and behavior, and your medical conditions.

Risks of Gastric Bypass Surgery:

Risks associated with the surgical procedure are few and rare. They might include:

Excessive bleeding
Infection
Blood clots in your legs
Lung or breathing problems
Leaks in your gastrointestinal system

All the above mentioned risks and complications can be identified early and taken care of only at a high volume and experienced center with staff especially trained in Bariatric Surgery.

Long term risks and complications of weight-loss surgery vary depending on the type of surgery. They can include:

Bowel obstruction
Dumping syndrome, causing diarrhea, nausea or vomiting
Gallstones
Hernias
Low blood sugar
Malnutrition
Ulcers
Vomiting

After gastric bypass and other types of weight-loss surgery the diet begins with liquids only, then progresses to ground-up or soft foods, and finally to regular foods.

You’ll also have to undergo frequent and regular medical checkups to monitor your health in the first several months after weight-loss surgery. You may need laboratory testing, blood work and various exams at fixed intervals to monitor the nutritional profile.

You have to keep all of your scheduled follow-up appointments after weight-loss surgery. It is mandatory to see your doctor immediately for any unusual symptoms or complications. You don’t need to weigh yourself frequently. Weight is monitored by the bariatric nurse and dietician at regular intervals. You might not lose enough weight or regain weight after any type of weight-loss surgery, even if the procedure itself works correctly. This weight gain may be due to loss to follow up or excessive liquid calorie intake. To help avoid regaining weight, you must make permanent healthy changes in your diet and get regular physical activity and exercise and follow all the instructions by your bariatric dietician.

Do I qualify for bariatric surgery?

Since, progressive generations are growing heavier with increased association with other metabolic disorders – diabetes, hypertension and dyslipidemia, there has been increasing role of bariatric surgery in the management of obesity and its associated co-morbidities. Technological leaps in the field of Laparoscopic Bariatric Surgery as well as Robotic Bariatric Surgery have led to the evolution of bariatric surgery from a major, uncommon and often dangerous surgery with doubtful outcomes to a much safer, routine procedure with assured results.

Initially it was a difficult task to elect candidates who could undergo bariatric surgery. In 1991 the National Institutes of Health (NIH) consensus statement for the first time defined clear universally acceptable criteria for patient selection. This statement was revised and re-defined as more and more data began to be analysed subsequently. The cut off BMI to undergo surgery was lowered over a period of time.

Starting with Gastric Bypass surgery, in which Roux-en-Y gastric Bypass being the gold standard, nowadays Gastric Sleeve Surgery is becoming more and more popular among surgeons since it is relatively simple to perform with similar post-operative outcomes.

With the understanding of the metabolic syndrome, of which obesity was just one part, there was increasing interest in the role of surgery in resolution of co-morbidities particularly diabetes and dyslipidemia.

The increasing incidence of diabetes and cardiovascular disease even at lower BMIs, particularly in specific populations such as Asians led to a demand to consider these surgeries for selected candidates with low BMIs also. The emphasis shifted from ‘weight loss’ surgery to ‘metabolic’ surgery. It was suggested that perhaps action points for Asians should be 2.5 BMI points lower i.e at 32.5 and 37.5.

With this background the International Diabetes Federation (IDF) released a position statement on 28^th March, 2011 supporting surgery to treat Type II diabetes in obese patients. It defined new lower BMI criteria for patient selection as explained in the table below.

Eligibility and prioritization for bariatric surgery based on failed non surgical weight loss therapy ⁺, BMI, ethnicity ⁺⁺ and disease control.

BMI range	Eligible for surgery	Prioritised for surgery
< 30	No	No
30 – 35	YES – Conditional ⁺⁺⁺	No
35 – 40	YES	YES – Conditional ⁺⁺⁺
> 40	YES	YES

+ In all cases patients should have failed to lose weight and sustain significant weight loss through non-surgical means, and have type II diabetes that has not responded adequately to lifestyle measures (+/- metformin) with HbA1c < 7%.

++ Action points should be lowered by 2.5 BMI points for Asians.

+++ HbA1c > 7.5 despite fully optimized conventional therapy, especially if weight is increasing, or other weight responsive co-morbidities not achieving targets on conventional therapies.

The new recommendations significantly lowered cut off BMIs making many more patients eligible for surgery. Theoretically an Asian patient with a BMI as low as 27.5 could be a candidate for metabolic surgery, provided other conditions are met. This is a significant shift from the previously recommended cut-offs.

These have received wide spread attention in the medical community and have been endorsed by several medical bodies – The American Heart Foundation (AHA), American Medical Association (AMA), The American Society of Metabolic and Bariatric Surgeons (ASMBS) and The American Association of Clinical Endocrinology (AACE).