The laparoscopic or open gastric-bypass with Roux-en-Y limb is a major surgical procedure. It is performed under general anesthesia, and involves a sophisticated manipulation and repositioning of the stomach and small intestine in ways that are both anatomically and physiologically significant. 

 

This office has extensive experience performing advanced laparoscopic and open procedures. Our surgical service is a high volume bariatric service with superb surgical outcome statistics and a very low rate of surgical complications. This procedure, however, remains a difficult and challenging technique and any of the following complications may occur.

 

• Mortality or Death.

o       All surgical procedures are assigned an average mortality rate based on complications or morbidity occurring within 30-days of the procedure.

o       These statistics are published in the American Medical literature and can be easily verified. For the laparoscopic gastric-bypass with Roux-en-Y limb the morbidity [major complication rate] rate is averaging 3.3% (major) and the mortality rate is averaging 0.1 to 2%.

         The Mortality Rate for the LGBRY on our service and for our surgical team is 0.

 

•  Risks to abdominal structures

o       Possible injury to intra-abdominal structures:  The spleen and the liver are large solid organs sharing space with the upper stomach where the gastric-bypass is done.  It is necessary to retract these organs to perform the bariatric procedure. Occasional tears and injuries can occur. If these problems occur they are usually identified and addressed during the primary procedure. In addition, injuries to other intra-abdominal and intra-thoracic organs can occur and may generate modifications to the planned procedure. Our rate for these complications has been negligible.

o       Anastomotic leak: A leak from the connection between the new gastric pouch and the small intestine is a serious intra-operative complication.  This is a rare occurrence. If a leak is eventually diagnosed, it may require an additional surgical procedure to repair it. To date,our leak rate is negligible..

o       Gastric staple line dehiscence: The portioning of the closure of the stomach [which is usually performed with a surgical stapling device] can open and leak. This is a rare occurrence with serious consequences.  For this reason we routinely leave a drain in place for a few days after the procedure.

o       Intra-abdominal abscess: A localized infection may occur in the abdomen after surgery for different reasons. This causes the formation of an intra-abdominal abscess or collection of pus that will need to be drained. 

o       Bleeding: Bleeding (within the first 24-hours) requiring a blood transfusion can occur and may even necessitate a return to the operating room. The most severe complication developed by morbidly obese patients is the formation of a blood clot in the legs and/or pelvis that travels to the lungs. This can create lethal problems. To prevent these clots, this office will routinely and aggressively anti-coagulate [or thin] the blood of patients with the drug Heparin. When the blood is thinned, post-operative bleeding can occur more frequently than usual. To date this office has recorded a negligible rate of post-operative bleeding, some of them however requiring a return to the operating room. There have been no recorded, long-term adverse complications from these events. However, by using this measure, only a negligible rate of pulmonary embolus [blood clot in the lung] has been recorded.

o       Bowel obstruction – or – Stenosis of the gastro-enterostomy: Post-operative obstruction after a laparoscopic procedure is rare but can occur.   A stenosis or “shrinkage” of the attachment of the small bowel to the new gastric pouch can occur.

 

• Risks of Open Case Surgery: 

Surgical complications associated ONLY with open cases [performed with an incision]. These complications do not occur with the laparoscopic gastric-bypass with Roux-en-Y. Our surgical team does open case on very rare occasions.

·        Ventral Hernia - Approximately 20% of patients will develop an incisional hernia after the open gastric-bypass. This is usually manifested 3 months or more after the surgery with the patient complaining of midline abdominal pain and exhibiting a bulge under the incision.  Repair of these hernias is necessary, but should be delayed until the patient’s weight and nutritional status have stabilized. Surgical mesh is frequently used in the process of repair.

·        Wound infection – Infection of the abdominal wound can occur.

·        Wound seroma – In some patients, sero-sanguinous fluid will form and accumulate under the closed incision. It may form a small lump or create a sudden sero-sanguinous discharge from the wound. This is a common complication and should be reported to the surgeon.

 

• Surgical Risks Specific to Obesity:

Obesity increases the frequency of systemic complications after major surgery.  Some specific risks are itemized below:

·        Pulmonary Embolus: Low mobility around the time of surgery can allow blood clots to form in the large leg veins (called a Deep Venous Thrombosis, or DVT).  These clots can travel to the blood vessels of the lungs (then called a Pulmonary Embolus, or PE).  This is a serious and life threatening event, usually manifested by shortness of breath, rapid heartbeat, and a feeling of weakness.  It is by far most likely to occur during hospitalization, but the risk of pulmonary embolus is present for the first month post-surgery. As mentioned earlier, the policy of this office is to anti-coagulate or thin the patient’s blood, which has dramatically decreased the rate of this complication. Another factor that has been shown to reduce the risk of pulmonary embolus is a short operating time. Shorter operating time decreases the rate of pulmonary embolus. This is why high volume bariatric services which perform this surgery most efficiently usually demonstrate the lowest risk of complications. However,walking as soon as possible after surgery remains the most important preventive measure for pulmonary embolus. Nurses will encourage the patient to use Pneumatic Stockings and to walk frequently. This is mandatory.

·        Pulmonary (lung) problems:  low ventilation, pneumonia, and fluid on the lungs (pleural effusion).  These complications occur within the first 72 hours after surgery or, in the case of pneumonia, within the first week.  Usually, they can be managed or avoided by early ambulation.  In rare cases, patients must have a breathing tube and be on a respirator for a few days.  Your nurses will encourage you to use a “blowing machine” or Incentive Spirometer.

·        Cardiac: Morbidly obese patients have a high incidence of coronary artery disease. To identify such a problem, this office meticulously screened you. The surgical procedure may precipitate acute heart trouble, which will lengthen recovery time and increase * surgical risks.