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Gastric Bypass Surgery Is Riskiest For Those Who Need It Most

Gastric bypass surgery has truly been a life-saver for the thousands of patients who have benefited from it.  However, in part due to the positive media coverage of high profile patients who have successfully undergone this procedure, many patients may be unaware that this surgery-like any other-carries significant risks as well as benefits.  Ironically, a recent study of 335 patients presented at the December 2003 annual meeting of the RSNA showed that the patients who truly need it most will also have the greatest risks during the procedure.  Morbidly obese patients are at increased risk of pneumonia, infection and pulmonary embolism during any surgery.  In addition, gastric bypass surgery carries the risk of torn sutures and stomach staple disruption in morbidly obese patients.  Gastrointestinal surgeries to help people lose weight are expected to nearly double this year to 100,000.

There are several different types of gastric bypass surgery.  This study focused on patients who all had Roux-en-Y gastric bypass at the University Hospitals of Cleveland from 1998 to 2002. Roux-en-Y is the most popular surgery in the treatment of severely obese patients to help weight loss. It involves stapling the upper stomach to create a small pouch that is then attached to the small intestine, reducing the capacity of the stomach. Subsequent radiologic imaging and other testing identified 57 complications from the surgeries - many of them multiple problems in the same patients - including suture tears and leaks, pulmonary embolism, pneumonia and infection.

While most people focus on the cosmetic and social aspects of being severely overweight, patients who are candidates for gastric bypass surgery should not consider this a cosmetic procedure, said Elmar Merkle, MD, the lead author of the study, who presented the findings at the annual meeting of the Radiological Society of North America (RSNA) in December 2003.  Dr. Merkle urged that "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 number of gastrointestinal surgeries for weight loss is soaring, according to the American Society for Bariatric Surgery, which estimates that the 63,000 procedures performed in 2002 will increase to 100,000 this coming year. Americans who are at least 100 pounds overweight are eligible for gastrointestinal surgery, according to National Institutes of Health (NIH) guidelines, but a patient who is less than 100 pounds overweight may also be considered a candidate if they have a life-threatening condition related to his or her obesity, such as type 2 diabetes or cardiopulmonary problems.

"Severely obese patients are considered to be at high risk for any type of surgery because of these co-morbidities," said Dr. Merkle, currently associate professor in the department of radiology at Duke University Medical Center in Durham, N.C. "In addition, there is a wide spectrum of procedure-specific complications following Roux-en-Y gastric bypass."

In the study, there were eight reports of anastomotic leaks and five instances of staple line disruption in the stomach, complications specific to Roux-en-Y. Three incidents of pulmonary embolism, two cases of pneumonia, and single cases of severe infection and open abdominal wound disruption were also reported - complications that are more prevalent among severely overweight patients undergoing surgery.  There were also two deaths within 30 days of the 335 surgeries, but no additional deaths have been reported in the nearly 600 gastric bypass surgeries performed to date.

Created: 1/14/2004  -  Donnica Moore, M.D.

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