Is Gastric Bypass Surgery Worth the Risk?

Weight-Loss Surgery Has Its Problems but Can Be Lifesaving for Obese People

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Dec. 2, 2003 (Chicago) -- Gastric bypass surgery can be lifesaving -- for the right person. A new study shows that many people will experience complications after surgery, but researchers say that it's worth the risk as a last option.

Stories about gastric bypass surgery, or "stomach stapling," have made this procedure sound like a miracle. But it's not the quick-and-easy fix that it might seem to be at first glance.

Gastric bypass surgery is great for motivated patients who are committed to permanent lifestyle change, according to lead researcher Elmar Merkle, MD. He presented his findings in Chicago at the annual meeting of the Radiological Society of North America.

"This should not be considered a cosmetic procedure," says Merkle in a news release. "People need to be aware of the potential complications of this surgery. It basically should be the last option we can offer the morbidly obese, after other less invasive interventions such as diet and exercise have been tried."

The procedure, known as gastric bypass surgery, attaches a piece of the small intestine higher up on the stomach and compartmentalizes the rest, so only a small portion of the stomach, approximately the size of an egg, is available for holding and digesting food. Therefore, patients feel full sooner.

And recently, gastric bypass surgery is being performed as a laparoscopic procedure, or through several small incisions, rather than one large incision. According to the National Institutes of Health guidelines, patients that are 100 pounds overweight can be considered for the surgery. Patients less than 100 pounds overweight may be considered if there is a life-threatening risk associated with their obesity, such as type 2 diabetes.

Merkle, associate professor of radiology at Duke University Medical Center in Durham, N.C., worked with a team of investigators when he practiced at University Hospitals of Cleveland. They followed 335 patients who underwent a type of gastric bypass surgery known as Roux-en-Y between March 1998 and December 2002.

Among these patients, 57 had complications and 17 required readmission to the hospital within 30 days after surgery. Two patients, or less than 1%, died as a result of postoperative complications.

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The complications included a leak in the juncture attaching the intestine to the stomach, which occurred in eight patients, and a disruption of the staple line compartmentalizing the stomach, occurring in five patients. Other complications of gastric bypass surgery included a blood clot in the lung, blood infection, bleeding, pneumonia, bowel obstruction, and injury to the esophagus. Merkle notes that these complications are more commonly seen among severely obese patients having any type of surgery.

These findings should not discourage people from considering gastric bypass surgery, but they should help them understand the serious nature of the surgery, according to James A. Madura II, MD.

"People who are considering this surgery need to know that the laparoscopic procedure is really the same one as the conventional surgery," he tells WebMD. "The new surgery is less invasive, and it's associated with fewer wound complications and a faster recovery, but the surgery on the internal organs is the same. It's a major surgical intervention."

Madura, who was not involved in the study, is the director of the bariatric surgery program at Rush University Medical Center, where he is an assistant professor of surgery. He urged that patients who are considering obesity surgery seek out an experienced surgeon. "Find someone who operates in a multidisciplinary center that is committed to the care of obese patients," he says.

"Gastric bypass surgery is not about losing weight the easy way and looking good -- the operation is about improving health," says Merkle. "There should be a long-term commitment by the patient. Eating habits must change. For example, patients will need lifelong vitamin supplements. Some patients lose weight, and then gain it back again. Not everyone gets the results they want, but they all face the risk of these complications."

WebMD Health News Reviewed by Michael W. Smith, MD

Sources

SOURCES: Radiological Society of North America 89th Scientific Assembly and Annual Meeting, Chicago, Nov. 30 - Dec. 5, 2003. Elmar Merkle, MD, associate professor of radiology, Duke University Medical Center, Durham, N.C. James A. Madura II, MD, director of bariatric surgery program; assistant professor of surgery, Rush University, Chicago. RSNA news release.

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