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HE DELICATE BALANCE OF RISKS AND BENEFITS IN BARIATRIC SURGERY

Bariatric surgery is performed to reduce the risks of potentially life-threatening weight-related health problems, the Mayo Clinic website explains, including:

  • gastroesophageal reflux disease
  • heart disease
  • high blood pressure
  • sleep apnea
  • type 2 diabetes
  • stroke

As with all major surgeries, there are risks associated with bariatric procedures, including excessive bleeding, infection, adverse reaction to anesthesia, blood clots, lung problems, and leaks in the gastrointestinal system.  Specific to weight-loss surgery, there are certain shorter term and longer-term risks and complications, the Mayo authors caution.

In the first 3-6 months following the surgery, patients may experience:

  • body ache
  • tiredness
  • feeling cold
  • dry skin
  • hair thinning or loss
  • mood changes

Longer term complications may include:

  • bowel obstruction
  • diarrhea, nausea, and vomiting
  • gall stones
  • hernias
  • hypoglycemia
  • stomach perforation
  • ulcers

The four most common methods used in bariatric surgery are:

1.    Roux-en-Y

This involves the creation of a walnut-sized “pouch” sealed off from the rest of the stomach, with the small intestine sewn directly into the pouch.  Food thus bypasses most of the stomach, entering directly into the middle part of the small intestine.

2.    Biliopancreatic diversion with duodenal switch

80% of the stomach is removed, and the end portion of the intestine is connected to the duodenum near the stomach. This surgery reduces not only the amount of food that can be eaten, but reduces the absorption of nutrients.

3.    Laparoscopic adjustable gastric banding

An inflatable band is positioned around the uppermost part of the stomach, Inflating the band separates the stomach into two parts,, creating a small upper pouch that communicates with the rest of the stomach through a channel created by the band.

4.    Sleeve gastrectomy

The structure of the stomach is changed to be tube-shaped, restricting the amount of calories absorbed. (This surgery can be the first part of the process for a biliopancreatic diversion.)

“Excessive abdominal adiposity creates exposure challenges, and often instrument length may be insufficient to reach the target.  To complete the operation safely and efficiently, proper patient positioning and operating setup are crucial,” Research Gate authors Gourash, Ikramuddin, and Hamad caution, referring to laparoscopic bariatric surgeries.  A white paper on the Action Products website by Robert B. Dybec, RN, MS, CPSN, CNOR discusses the challenges implicit in each surgical position:

  • the supine patient finds respirations difficult and may need to have the back elevated
  • the Trendelenburg position may lead to fatality due to cardiorespiratory decompensation
  • the prone position is not well tolerated by the overweight patient
  • the lateral position is usually well tolerated by obese patients

The authors conclude that “the care of the obese patient in the OR is a unique situation requiring care, compassion, knowledge, special equipment, and most importantly, teamwork and planning to ensure a safe surgical experience.”