Gastric Bypass Surgery: The Hope and the Hazards
Obesity, often defined as having a body mass index (BMI) of 30 or over, has been increasing nationally over the past few decades, and Indiana’s obesity rate is no exception. In a recent report, “The State of Obesity: Better Policies for a Healthier America,” Indiana’s ranking was the seventh-worst in the country.
Our state’s rate means that nearly one-third of adults—32.7 percent, up from 20.5 percent in 2000—are currently obese. Arkansas is the state with the highest rate of adult obesity, at 35.9 percent, followed by West Virginia, Mississippi, Louisiana, Alabama, and Oklahoma. Rounding out the top ten after Indiana are Ohio, North Dakota, and South Carolina.
The approximately 78 million U.S. adults who are obese risk a wide range of health problems, including diabetes, heart disease, hypertension, sleep apnea, and some forms of cancer. Considering that a significant portion of our health care dollars are spent on diseases or conditions related to obesity, it’s no surprise that the incidences of bariatric (weight loss) surgery are also on the rise.
Many of the more popular varieties of bariatric surgery involve various kinds of gastric bypass. Bypass surgery carries some risk, with slightly less than one-half of one percent of all patients dying during or within 30 days after surgery. However, if the patient is extremely overweight with other health complications that will be helped by losing weight, the risk of dying from obesity can be greater than that of surgery. The surgery then becomes a worthwhile risk for some.
Though the risks of death and permanent injury can be low, depending upon the doctors and the hospital involved, it does not mean things can’t go wrong. In the hands of a less competent or negligent surgeon, gastric bypass surgery can and does have serious complications.
How Does a Gastric Bypass Work?
A gastric bypass works much the way it sounds. A very small pouch is created using the upper stomach, with the rest of the stomach not available for food, or bypassed. A gastric bypass usually reduces the size of the portion of the stomach that can hold food by 90 percent, restricting the volume of food that can be eaten. This means that fewer calories are taken in, resulting in weight loss.
A successful bypass also requires the gastrointestinal tract to be reconfigured so that both parts of the stomach, the small section taking in food and the larger bypassed section, can drain. Often, a portion of the small intestine is connected to the reconstructed stomach.
Variations on the basic surgery exist, one of which is the Roux-en-Y laparoscopic gastric bypass. The Roux-en-Y is considered one of the more difficult procedures to perform, with a slightly higher mortality rate. However, it comes with benefits such as a shorter recovery time, a shorter stay in the hospital, and less scarring and discomfort.
What Can Go Wrong?
Difficulties from gastric bypass surgery can and do happen. Certain complications can arise from surgery in general, and abdominal surgery in particular, especially among patients with preexisting health conditions such as diabetes:
- Deep vein thrombosis/pulmonary embolism. Pulmonary embolism is the most common cause of death in gastric bypass patients.
- Problems with anesthesia, which are greater in number for obese patients.
- Wound infections. Diabetic patients have a higher risk.
- Obese patients have a greater risk of post-operative pneumonia and need more aggressive respiratory care.
- Bowel obstruction from scarring.
- Incisional hernia.
Risks specific to the various gastric bypass procedures, and the reasons for complications arising from them, include:
- Leaks (the area where the bowel and stomach are connected doesn’t “seal” as quickly as it should). Nationally, four percent of surgery patients suffer post-operative leaks. Treatment can require additional surgery.
- Strictures (a narrowing of the attached area between bowel and stomach due to scar tissue). Strictures usually happen between the first and third months after surgery, and in four to five percent of patients. An outpatient procedure, endoscopic dilation, is usually done.
- Internal hernia (the bowel twists, blocking itself). Between four and five percent of patients develop this problem, with surgical repair needed to fix it.
Malpractice Causes and Cases
The biggest reasons for malpractice cases usually result from less than optimal post-operative care:
- Post-operative leaks, and the failure to diagnose or treat them quickly, are the leading reason for gastric bypass malpractice cases. While the leak itself may or may not be considered negligence, not recognizing the signs of a leak may well be.
- Either deep vein thrombosis or pulmonary embolism, and the failure to diagnose and treat them. Both of these are life-threatening conditions, and not diagnosing them appropriately may be considered negligence.
- The failure to diagnose and treat abscess and/or infection, sometimes arising from internal hernia or other intestinal twisting. Not diagnosing them appropriately may be considered negligence.
One final factor to consider is the experience level of the surgeon. Some surgeons have begun doing the procedure because it is popular, and inexperienced doctors have a higher complication rate. During a surgeon’s first 19 procedures, the odds of death within 30 days of the procedure are 4.7 times higher.
In one case, a woman in the Chicago area received more than $14 million combined from both the doctors and the hospital where her gastric bypass surgery was done after being left with brain damage due to the use of the wrong blood-thinning medication. In a second case, the family of a patient in the St. Louis area who died was awarded $3.5 million on the part of the hospital and the surgeon due to negligence. (Nothing more can be revealed about this case as it was a confidential settlement.)
We at McNeely Stephenson recommend you always check online court dockets and state medical licensing board websites for legal complaints against any surgeon you might be considering. You should also check the experience level of the doctor performing your gastric bypass. Finally, if you are not seriously obese—defined as having a BMI of at least 35 to 40—you may be better off with diet and exercise rather than trying surgery.