Obesity risks add to complications of gastric bypass

December 01, 2003

CHICAGO -- The same health risks that make morbidly obese patients eligible for gastric bypass surgery also leave them susceptible to complications during and after the procedure, according to a five-year imaging study led by a Duke University Medical Center radiologist.

The study followed patients at the University Hospitals of Cleveland after Roux-en-Y gastric bypass surgery, the most popular surgical procedure to aid weight loss in severely obese patients. The surgery involves stapling the upper stomach to create a small pouch that is then attached to the small intestine, thereby reducing stomach capacity and the intestine's ability to absorb nutrients.

Among the 335 patients that participated in the study, radiological imaging revealed 57 complications from the surgeries -- many of them multiple problems in the same patients -- including suture tears and leaks, pulmonary embolism, pneumonia and infection.

"Severely obese patients are at high risk for any type of surgery because of other conditions related to their weight," said Duke radiologist Elmar Merkle, M.D., formerly of the University Hospitals of Cleveland where the study was conducted. "In addition, there is a wide spectrum of procedure-specific complications following Roux-en-Y gastric bypass."

Merkle presented the findings today (Dec. 1, 2003) at the 89th Scientific Assembly and Annual Meeting of the Radiological Society of North America.

The results emphasize that the procedure should be a last resort after all other interventions, such as diet and exercise, have been attempted, said Merkle. The findings also highlight the importance of radiological imaging in diagnosing surgical complications in severely obese patients following gastric bypass, he added.

The researchers reported eight cases of leaks from the stomach into the surrounding abdominal cavity and five instances of staple line disruption in the stomach, complications specific to Roux-en-Y. They also observed three incidents of pulmonary embolism, two cases of pneumonia, and single cases of severe infection and open abdominal wound disruption -- all complications that are prevalent among severely overweight patients undergoing any surgical procedure. Within 30 days of the surgery, 17 patients were readmitted to the hospital.

"This operation should not be considered a cosmetic procedure," Merkle said. "People need to be aware of the potential complications of gastric bypass surgery and treat it as a last option after other less invasive interventions have been tried."

In addition to its complications, the procedure also requires patients to undergo major lifestyle changes, he said. Following the surgery, patients must restrict their eating habits and rely on vitamin supplements for adequate nutrition.

According to the American Society for Bariatric Surgery, 63,000 people had gastric bypass surgery in the U.S. in 2002. That number is expected to increase to 100,000 this year. The National Institutes of Health guidelines state that patients who are at least 100 pounds overweight are eligible for the surgery. Patients who are less than 100 pounds overweight may also be considered based on other life-threatening conditions related to obesity, such as type 2 diabetes or cardiopulmonary problems.

Co-authors of the study were Thomas Stellato, M.D., Cathleen Crouse, Peter Hallowell, M.D., and Dean Akira Nakamoto, M.D., all of the University Hospitals of Cleveland.

Duke University Medical Center

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