Gastric bypass surgery is riskiest for those who need it most

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 surgery, a study of 335 patients shows.

The patients 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 helped to identify 57 complications from the surgeries - many of them multiple problems in the same patients - including suture tears and leaks, pulmonary embolism, pneumonia and infection.

"This should not be considered a cosmetic procedure," said Elmar Merkle, M.D., the lead author of the study, who presented the findings today at the 89th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA). "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 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 if there is 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, according to Dr. Merkle.

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.

"Gastric bypass surgery is not about losing weight the easy way and looking good - the operation is about improving health," Dr. Merkle said. "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, then gain it back again. Not everyone gets the results they want, but they all face the risk of these complications."

Co-authors of the study were Thomas A. Stellato, M.D., the Charles A. Hubay M.D. Professor of Surgery, founder of the bariatric program at University Hospitals of Cleveland; Cathleen Crouse, R.N., the coordinator of the bariatric program at University Hospitals; Peter T. Hallowell, M.D., who performed part of the operations; and Dean Akira Nakamoto, M.D., the director of body imaging at University Hospitals.
-end-
RSNA is an association of more than 35,000 radiologists, radiation oncologists and related scientists committed to promoting excellence in radiology through education and by fostering research, with the ultimate goal of improving patient care. The Society is based in Oak Brook, Ill.

Note: Copies of 2003 RSNA news releases and electronic images will be available online at www.rsna.org/press03 beginning Monday, Dec. 1.

Editor's note: The data in these releases may differ from those in the printed abstract and those actually presented at the meeting, as researchers continue to update their data right up until the meeting. To ensure you are using the most up-to-date information, please call the RSNA newsroom at 312-949-3233.

Radiological Society of North America

Related Weight Loss Articles from Brightsurf:

Weight loss shouldn't be the goal of PE
For adults, the goal of exercise is often to shed some pounds, but new research from the University of Georgia suggests the objective should be different for kids.

How long should you fast for weight loss?
Two daily fasting diets, also known as time-restricted feeding diets, are effective for weight loss, according to a new study.

Green tea may help with weight loss efforts
In an analysis published in Phytotherapy Research of randomized controlled trials, individuals who consumed green tea experienced a significant decline in body weight and body mass index.

Changing weight-loss strategies, attempts
The proportion of adults who tried to lose weight in the previous year increased from 1999 to 2016 but the findings of this observational study suggest the results may have been unsatisfactory.

Quality of life changes after weight loss
Obesity increases a number of adverse health consequences including reduced health-related quality of life.

Weight loss medicines underutilized by veterans
Despite the availability of new weight management medications and several clinical guidelines recommending their use as part of a comprehensive treatment plan for obesity, a new study has found that their use is extremely low (about one percent) among eligible Veterans.

Is the most effective weight-loss strategy really that hard?
Dietary self-monitoring is the best predictor of weight-loss success. But the practice is viewed as so unpleasant and time-consuming, many would-be weight-losers won't adopt it.

Study: Faster weight loss no better than slow weight loss for health benefits
Losing weight slowly or quickly won't tip the scale in your favor when it comes to overall health, according to new research.

Mindfulness training may help support weight loss
Mindfulness training may improve the effectiveness of intensive weight management programs, according to a small study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

Does weight loss before surgery provide benefits?
For obese and overweight patients, it is common for various surgical procedures to be deferred until they have lost weight through diet and exercise.

Read More: Weight Loss News and Weight Loss Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.