June 17, 2022 - Weight Loss Surgery: Bariatric Surgery Risk and Complications 

For this week’s Bariatric Friday, Kemal Erkan, Chairman of American Surgery Center is accompanied by Dr. Isaias Irgau, President of Christiana Institute of Advanced Surgery (CHRIAS). This dialogue focuses on the risks and complications that go with undergoing bariatric surgery, also known as weight loss surgery.  

We are reminded of the two hypothetical patients, Katrina and Samantha. The pair are both undergoing weight loss surgery but in two different methods. Katrina is thirty-seven years old with a body mass index (BMI) of forty-seven and no history of diabetes. She is receiving a gastric sleeve. Samantha is sixty-two years old with a BMI of forty-two. She is getting a gastric bypass because of two reasons, her age and the fact that she has the preexisting conditions of diabetes and heartburn. These patients, when they return home, have family members who are worried about their loved one undergoing bariatric surgery. It is important to know and understand the risks associated with going through the procedure. Dr. Irgau has performed thousands of these surgeries in the last twenty-two years, so he has immense education and advice on the subject.  

“Bariatric surgery is by far the most effective treatment that we currently have to treat morbid obesity,” Dr. Irgau proclaims, “that is obesity that has become… so extreme that it is causing illnesses by itself… like type 2 diabetes, high blood pressure, sleep apnea, and many other conditions”. The surgery relieves the individual from the burden of carrying extra weight on an everyday basis as well as treating these coinciding illnesses. Obesity, to the general public, is not seen as a disease. The stigma around obesity is a misunderstanding of people thinking that those who are obese can simply lose the weight. It is quite the contrary. These individuals can try to lose weight time after time and not see a result. The media plays into this stigma as well. There are books, television shows, movies, and more that constantly ridicule people who are obese. It is important to think if this happened to your loved one, how would you feel.  

In the past, there were no programs in place for those undergoing bariatric surgery. American Surgery Center has taken this issue and formed an involved program between the patient and the surgeon to ensure the patient is educated, prepared, and receiving continued care after the procedure. American Surgery Center is recognized as a center of excellence due to their high levels of safety and quality.  

With that, it is still important to note that bariatric surgery is a major procedure. “There is no surgery without potential risks, but the levels of those complications, particularly in centers like ours, are extremely low now to make the surgery very much acceptable,” Dr. Irgau explains, “the benefits far outweigh the risks”.  

“Today we are talking broadly,” Dr. Irgau mentions, “in the short term, when we look at potentially serious complications, there are three complications that are relevant to consider”. The first is leaks. Leaks are caused by improper healing of the wound from the division of the stomach. If it does not heal correctly, the substances that are meant to remain inside the stomach or intestine can leak into the abdomen and cause an internal infection. This complication is very rare, and if they do occur, American Surgery Center is equipped to address and solve the issue. Leaks are detected in post operational visits with the patient. The patient will experience issues such as pain, nausea, or vomiting. The second complication is the formation of blood clots. Having the patient up and walking early and frequently after surgery is a great way to prevent this from occurring. Blood thinning medications can be taken before the surgery to prevent blood clots as well. During the procedure, boots designed to increase blood circulation are placed on the patient. All of these preventative methods aid in reducing the likelihood of the serious complication. The third is bleeding. This is a complication of any surgery. At American Surgery Center, they utilize special buttressing materials to ensure a minimized bleeding risk. All three of these complications are very well controlled because of the preventative measures taken.  

“One of the greatest advances in surgery for us, especially abdominal surgery, Kemal, is that we have been able to undertake complex surgeries inside the abdomen now with very small incisions,” Dr. Irgau says, “when I was in training, in medical school, the vast majority of abdominal surgeries were being done with big incisions… every time you have such a large incision… the risk for infection was very very high… now because we undertake the surgery with very small incisions, wound infection by itself is extremely rare nowadays”. There are many other factors that minimize the infection of the found, including antibiotics and the immense preparation prior to the procedure.  

“How would Samantha prepare differently than Katrina,” Erkan prompts. Dr. Irgau mentions that the conversation regarding risks and benefits happens during the first meeting of the patient and the doctor. Samantha, because she has diabetes, has a different conversation at the first meeting than Katrina. Their age gap may coincide with a variety of complications; however, the precautions are taken universally. Every patient’s journey is personalized no matter what their circumstances are. “We are not performing a cosmetic procedure, we are performing a life-saving procedure,” Dr. Irgau proclaims. Samantha is walking with illnesses that may be life threatening, so it is important to understand the risks while understanding the great benefits. “Doing a procedure that will relieve her of the weight is not taking only the weight off her so she can look good… but more importantly we are taking away this burden over her head of possibly dying early, so when you look at that potential… then yes, the risks are completely acceptable particularly with the way that they are so low in their occurrence,” Dr. Irgau states.  

Erkan asks Dr. Irgau to explain the after-surgery process in preventing complications. Dehydration is a big issue after bariatric surgery. Because the size of the patient’s stomach has been reduced, the capacity of water that can be held is much smaller. This can cause a vicious cycle of dehydration. This is relatively common, but Dr. Irgau mentions a way that he helps his patients with this problem, “if they are not talking, if they are not sleeping, they should be sipping water”. To prevent thirst, patients should be sipping small amounts of water at a time throughout the entire day rather than a large amount here and there. Erkan closes by saying that these Bariatric Fridays are not only a way for them to communicate with their patients but also to educate potential patients and learn themselves.