SIDE EFFECTS GASTRIC BYPASS
By Dr. Norman Samuels

Risks

Gastric Bypass is a major operation, and carries with it hazards of major surgery in general. These risks are usually increased in the obese patient.

Before deciding whether to have surgery it is important for you to know that the potential complications include:

Please also note that obesity surgery is not a miracle procedure or an easy way out. After an otherwise successful operation, it is possible to ignore your instructions and "out eat" the operation, thereby failing to lose weight or reversing an initial weight loss at a later time.

For greatest success following the operation, you must establish correct eating habits that include the selection and proper consumption of nutritious foods. The surgery makes this easier for you because the small pouch and small outlet to help to eliminate continual hunger and place a limit on the amount you can eat at one time.

However, you play a critical role in achieving permanent weight loss and, of course, you are the main beneficiary. The necessary adjustments to your present habits will be yours to make, but the pride and feeling of accomplishment as you lose weight will be yours as well.

If you are not willing, (or think you are unable) to make these adjustments, then you will only be wasting your time and money - and exposing yourself to unnecessary risks - by having this operation.

Decision

The decision to undergo surgery for control of obesity should not be taken lightly. Because of the mental and physical effort required on your part to achieve success, your decision should be made only after careful thought and discussion with your family.

If you have any questions about the surgery, or what it entails, feel free to contact me thorugh Surgical Team.

Then, if you should decide you would like to have the operation, you should make an appointment for a physical examination and to arrange for the needed pre-operative tests.

Whatever your decision, I wish you every success. If you do have the operation, I promise that I will do my very best for you before, during and after the surgery itself. With your cooperation, we can then hope to achieve a satisfactory and lasting result.

SIDE EFFECTS ADJUSTABLE GASTRIC BANDING
By Dr. Göran Hellers

As any surgical procedure, AGB is associated with some degree of risk, but is overall a very safe procedure with few severe side effects. The risk-benefit assessment of the procedure needs to be done in the context of the original condition.

Short-term complications:

Vomiting
Most patients will once or twice feel pain or vomit after intake of food. This is in most cases caused by eating too much and too quick. If eating is slow and calm, patients will learn to listen to the signals from the stomach. Eating should be abandoned if the patient feels nauseated, have pain or vomits. Regular vomiting is a sign of warning. This can either be caused by wrong eating behavior or be caused by the outflow of the gastric pouch becoming too narrow. This means that the balloon may need to be adjusted. Regular vomiting should be discussed with the physician in charge and corrected.

Constipation
Many patients feel constipated after surgery. This is mainly caused by the fact that the reduced food intake leads to less feces and it is thus normal with fewer bowel movements. If laxatives become necessary, it is advisable to abstain from so called bulking agents and instead use liquid laxatives, such as lactulose.

Hair loss
Many patients are suffering from increased hair loss during the first six months after surgery. This is also caused by the relative starvation. This however never leads to baldness and normal hair growth will eventually return.

Long-term complications:

Adjustable gastric banding is well tolerated by most patients. Complication rates are low but this does not mean that complications are non-existent. The following is list of the complications that have been seen following this operation;

Infection
There has been a few cases of deep infection in the abdomen leading to removal of the band. There has also been some infections of the port system leading to removal of the port. These events must be regarded as failures of the operation. Sterility during injection is obviously of great importance in order to minimize or avoid this complication.

Band Problems
Three bands broke early in our series. Since then the band has been reinforced with additional dacron mesh and this complication has since then not occurred. In five other cases the balloon has broken and these patients immediately started to gain weight. The balloon has also lately been reinforced in order to withstand increased pressure. All these cases had to be reoperated. Although we have now improved the implant it must be pointed out that a definite guarantee against technical problems like these can never be given.

Band Migration
There are two types of bands that we use. There is a Swedish band (sold by Obtech AG) and a French band (sold by Lowate AB). Migration occurs when the band and balloon migrates through the stomach wall into the stomach lumen. These cases are outright failures and these patients have quickly regained their preoperative weight. This has so far occurred in about 3% of the cases when the Swedish band has been used. With the French band there are no migrations at this point in time. The French band has however been used much shorter time and since migration usually does not occur until 18-24 months after surgery it is too early to say which band will be the better in this respect. Patients who have their bands filled quickly and with high total volumes have an increased risk of migration. Filling must be slow and gradual. Total volumes over 9 ml should be avoided with the Swedish band and 5 ml with the French band. If these guidelines are observed the frequency of this type of complication will decrease.

Port Problems
There has been port problems in about 4% of the cases. There has been two types of problems. The first is dislocation of the port. It may move around, turn up-side-down and can in this position not be injected. It is thus necessary to adjust it. This is a simple operation in local anesthesia but nevertheless a nuisance to the patient. The second problem is perforation of the connecting tube close to the port. Some patients have extra fat over the chest and it is therefore sometimes difficult to hit the ”bulls eye” with the needle and the tube may be accidentally perforated. This leads to loss of fluid, widening of the opening and subsequent weight gain. This is also corrected in local anesthesia. The port is brought to the surface, a bit of the tube including the hole is cut off, and the remaining tube is reattached to the port and finally the port returned into position. The design of the system has because of this problem been changed. The distal 2 cm of the tube is now covered with a protective sleeve in order to avoid this problem.

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