Complication is the big C word for weight loss surgery. Every procedure regardless of how simple and routine (even a tonsillectomy) has inherent risks. One of the most important skills of an experienced surgeon is to always weigh the benefits of the procedure against the risks. A good surgeon will at times refuse to perform some procedures because in his opinion the risks are higher than the benefits. It is a shame that someone like Michael Jackson didn’t work with surgeons who were able to say NO!

We would all like to pretend complications are either the result of a poor surgeon, or related to patient behavior. If we can conveniently blame the complication on either of those two items, then we feel safe because we chose a good surgeon and we are going to follow the doctor’s orders perfectly, therefore we are exempt from complications.

Unfortunately, complications can happen to anyone and they can also happen with highly trained surgeons, compliant patients in good medical settings. Surgery is not a perfect science, it is an art combined with science and there are always variables out of the surgeon and patients control. If your potential surgeon says he has never had a complication – RUN! He is not being honest with you as a surgeon that has never had a complication has not had much experience or is lying.

There are certain complications inherent with anesthesia; these can be minimized by using a highly qualified anesthesiologist who has reviewed an accurate medical history and pre-operative examinations of the patient. The anesthesia risk can be managed by complete patient honesty and careful patient selection but the risk can never be eliminated due to the nature of anesthesia.

The biggest risk factors resulting in complications for weight loss surgery are:

1. Previous weight loss surgery – revisional surgery is always presents higher risks due to adhesions present in the tissue and integrity of the tissue. Stomach tissue that has had a band over it does not always have the same elasticity, blood supply and integrity as tissues that have been surgically altered. Staples hold better in virgin tissue resulting in a lower propensity of leaks.
2. Leakage is every surgeons and patients worst nightmare. Leakage is the result of staple line and stitching failure. Leaks have the potential to be fatal if not treated immediately. Previous weight loss surgery patients revising to a second procedure have significantly higher risks of leakage.
3. Risks of bruising of the liver – your liver in anatomically packaged adjacent to the stomach. During a bariatric procedure the liver must at times be held with retractors off of the stomach so the surgeon has a clear field of vision and area to work. When people are obese, their livers are fatty and mushy with a propensity to bruise. By using a pre-op diet for as little as 2 weeks, a fatty, mushy liver firms up significantly thus reducing the risks for liver damage. The purpose of the pre-op diet isn’t to lose weight or to punish obese patients – it is in fact to insure your safety during your procedure!
4. Smokers always have higher risk factors related to tissue that hasn’t received proper oxygen which delays the healing process and leaves the patient exposed to risk of infection during the healing process.
5. Infection is always a risk for any procedure – any time skin is punctured. The risk of infection is minimized by using sterile techniques, selecting patients that are in reasonably good health and appropriate use of antibiotic medications.
6. That nasty bowel prep you were asked to do preoperatively is to leave the digestive tract clean of material that could cause infection during the procedure and also gives the surgeon more room to work. Some patients try to avoid the bowel cleanse but it is an important factor in your safety.
7. Fill out your medical history accurately. We all understand how unhappy we are as obese persons. We can minimize our surgical risks by allowing our surgeon to have a total view of our health by being completely honest about previous procedures, previous or current disease processes and current medications and dosages. This information will allow your surgeon to plan your surgery and to manage your risk factors appropriately.

There is risk in everything we do, from stepping out of bed in the morning, driving to work, mowing the grass, each and everything we do has a degree of risk. By carefully assessing every situation we manage our risk factors daily and that is what your surgeon is trained to do. The surgeon and his team are on your side – they want to help insure your procedure is safe, uneventful and successful. You can do your part by giving them the information they need to keep you safe and by following their guidelines and requests. We want you to be aware that while there is always risk in every procedure, we do our best to minimize those risks and provide you with the maximum benefits.