Complications of Laparoscopic Gastric Bypass RNY

Complications of Laparoscopic Gastric Bypass RNY

Gastric bypass surgery is good for reducing weight, weight loss is more predictable and usually maintained more after gastric bypass surgery. Average excess weight loss is usually higher than with purely restrictive procedures like gastric banding.
One year after gastric bypass surgery, weight loss can average 60% to 70% of excess body weight. After 10 to 14 years, some patients have maintained 40-50% of excess body weight loss.
90% of certain associated health conditions like back pain, sleep apnea, high blood pressure, diabetes and depression improves or resolved after gastric bypass or any weight reducing surgery. It also helps in leg swelling, high cholesterol, urinary incontinence etc.
Complications of Laparoscopic Gastric Bypass RNY

A. Bleeding : sometime large amount of blood is lost, and patient may require blood transfusion. The incidence of blood transfusion are less than 4 percent. Rarely delayed bleeding may require re-surgery.
B. Anesthetic complications: Risk undergoing general anesthesia has a risk of having respiratory complications. Obese patients have extra stress on the chest cavity and lungs. This means a greater risk of pulmonary problems and pneumonia developing after surgery. Stopping smoking four weeks before surgery, sitting up in the bed in the evening after surgery and performing breathing exercises will help in decreasing the risk.
C. Venous thrombosis: Blood clots in the calf muscle of leg occur more often in obese. Smoking and hormonal contraceptive pills increase the risk. The clot rarely can migrate to lungs causing Pulmonary Embolism. Heparin therapy and compression stockings should be used in all patients with laparoscopic surgery. The best way to reduce this risk is to exercise the leg calf muscles to maintain blood flow. Walking and early mobilization is the best therapy to prevent blood clots, but even moving the feet and ankles up and down while lying in bed helps.
D. Failure of anastomosis:  leak in the stomach can occur in few patients of gastric bypass surgeries. Leakage of gastric content can cause peritonitis. This may necessitate an emergency surgery to repairor drain the leak.
E. Intestinal obstructions may develop in few patients after surgery. Most common causes are adhesions and internal herniation. It may require a repeat laparoscopy or sometimes even open surgery to release the band of the obstruction.
F. Infections in the incision occur in few patients after laparoscopic gastric bypass surgery. This requires drainage and regular dressings so that they heal from inside out. Occasionally, in a serious infection, a second surgery may be required.
G. Death. About 1 in 200 to 1 in 300 people who had gastric bypass surgery die from the procedure. With laparoscopic gastric bypass, the average mortality is significantly less. Weight experts and bariatric surgeons consider the known risks and health dangers of severe obesity to be greater than those resulting from weight loss surgery
H. Dumping syndrome. When stomach contents are literally “dumped” more rapidly into the small intestine. Dumping syndrome is usually triggered by too much sugar or large amounts of food, dumping syndrome doesn’t pose a serious health risk, but its symptoms aren’t fun: nausea, weakness, sweating, faintness, and diarrhea. Some patients can prevent dumping syndrome by avoiding taking sweets after surgery.
I. Bowel problems. After gastric bypass surgery, there may be a period of intestinal adaptation. During this time bowel movements can be frequent with diarrhea. This bowel complaint, frequently accompanied by bloating, gas and foul smelling stools, may reduce with time.
In the first three to six months, the patient may experience one or more of the following changes as the body reacts to rapid weight loss:

• Body aches
• Feeling tired
• Dry skin
• Hair thinning
• Hair loss
• Changes in mood
• Sexual inactivity
Patients may develop gallstones after rapidly losing weight in about 25% of cases. The risk of gallstones can be reduced to 2% by taking bile salts for 6 months following surgery.
J. Hernia of incision site occurs in about 2 percent of patients after laparoscopic gastric bypass (15 percent after open weight-reduction surgery). This usually requires surgical repair, depending on the symptoms and the extent of the hernia.
K. Narrowing or “stricture” of the stoma of anastomosis between the stomach and intestine is a rare complication. When foods are not chewed properly and get stuck or have difficulty passing through the stoma, they cause scarring. When scarring occurs, it becomes more difficult for the food to pass. It is suspected when vomiting occurs most of the times after food. The stoma can be stretched by a gastro enterologist in the outpatient with a dilating tube that is passed to the stomach through the mouth (endoscopic dilatation).
L. Ulceration of the small intestine to the upper part of the stomach may occur in 5 percent of people who have gastric bypass surgery. Ulcers are more common in people who take aspirin or other medications called non-steroidal anti-inflammatory agents.
M. Malnutrition: Almost a third of patients may develop nutritional deficiencies. Because the duodenum is bypassed in this procedure, the body cannot absorb important minerals like: iron, calcium, zinc, selenium and other nutrients efficiently after gastric bypass surgery. Fortunately, these deficiencies can usually be controlled with proper diet and vitamin supplements.

N. Iron deficiency anemia. Duodenum is bypassed in this procedure, the body doesn’t absorb iron and calcium very well after surgery, which can lead to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during menstruation or from bleeding hemorrhoids. Taking a tablet daily of multivitamin and iron will prevent or reverse this process.
O. Osteoporosis. Because the body doesn’t absorb calcium properly after surgery, there is a greater risk of developing osteoporosis. Daily supplementations of calcium will prevent osteoporosis.

 

P. Metabolic bone disease. Also caused by bypassing the duodenum, some patients experience bone pain, loss of height, humped back and fractures of the ribs and hip bones.

Q. Chronic anemia. A type of anemia caused by a deficiency of vitamin B12 can usually be managed with pills or injections, which will be taken life long.

 

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