Obesity is a growing problem nowadays. Many people, who are overweight or obese, and would like to achieve lasting weight loss, avoid surgery because they are worried about the risks related to bariatric surgery.

Bariatric surgery had a reputation for being risky 20-30 years ago. However, the procedures have improved over the years and have become very safe. Firstly, high risk surgical methods, like duodenal switch or biliopancreatic diversion, have been replaced with safer procedures, such as gastric bypass surgery and gastric sleeve surgery. Also, nowadays 99.9% of bariatric surgeries are performed using minimally invasive methods (laparoscopic) methods. Laparoscopic surgery is considerably safer for the patient than open surgery.

However, no surgery is 100% risk-free. The surgical risk depends on a person’s age, body weight and overall health status.

Risk of death and complications

Mortality following bariatric surgery is rare. Risk of death due to surgical complications is 0.02-0.05%. This rate is considerably less than most other surgeries, including surgical removal of the gallbladder (cholecystectomy) and appendix (appendectomy).

After the bariatric surgery serious complications can occur in 2-3% of patients. These complications are usually readily treatable when diagnosed in time.

Table – Bariatric Surgery risks

Early complications

The most common early post-surgical complications are bleeding (1%), leakage through the stomach or intestinal stitches (0,5-0,8%) and bowel obstruction (0,1% to 0,6% depending on the procedure type). In most cases the bleeding resolves without any medical intervention, however on some occasions, a blood transfusion is necessary. Leakage and bowel obstruction require another surgery.

The need for emergency re-operation is less than 1%.

Deep vein thrombosis or pulmonary artery embolism is very rare and occurs only in 0.1% of the patients. The introduction of blood thinners, compression socks and early physical activity into the management of bariatric patients, have greatly minimized the risk of these conditions.

Late complications

Complications are considered late if they occur 30 days after the surgery.

Possible late complications after standard Roux en-Y gastric bypass surgery may include internal hernia with ileus or stomach pain (2-5%), iron deficiency anaemia, severe dumping syndrome, peptic ulcers.

Frequent complications after gastric sleeve surgery include iron deficiency anaemia, vomiting and acid reflux (heartburn), that sometimes may require revisional surgery.

An acid reflux requiring revisional surgery can also develop after a mini-bypass surgery. Other possible complications after mini-bypass are peptic ulcers, iron deficiency anaemia, malabsorption of different vitamins and mineral, food intolerances and severe dumping syndrome. Most of these problems are avoidable if nutritional recommendations after bariatric surgery are followed.

Risks associated with the healthcare provider

It is important to thoroughly consider where and by whom the surgery is performed.
When choosing a bariatric surgeon and clinic, then it is important to do a research about their background: how many surgeries they perform yearly, what type of support is provided and what is the feedback of previous patients. Accomplished and professional clinics are those that perform at least 100 bariatric surgeries per year. A high number of surgeries ensures that exceptional and safe surgical standard is maintained and offered to every patient.

The risks of being overweight

Even though no surgery is completely risk-free, neither is obesity.
In the long-term obesity may be more dangerous than surgery. Individuals with severe obesity can have several life-threatening conditions that greatly increase their risk of premature death up to 50% when compared to normal weight individuals. Bariatric surgery can significantly reduce the risk of premature death. Common health issues linked to being overweight or obese include high blood pressure, type 2 diabetes, sleep apnoea, non-alcoholic fatty liver disease and a higher risk of cancer. Many of these conditions can be relieved or resolved with surgical weight loss.

Reasons for considering bariatric surgery

1. Quality of life is improved in 97% of patients.
2. The risk of cardiovascular diseases lowers.
3. There is a 60% chance that blood pressure normalizes.
4. There is an 80% chance that metabolic syndrome recedes.
5. There is an 85% chance that sleep apnoea is relieved or resolved.
6. Improved control of type II diabetes in all patients after the surgery. Many patients can reduce or stop taking their diabetes medication.
7. Reduced depression rates in 55% of patients.
8. There is a 60% chance that blood cholesterol levels normalize.
9. With the gastric bypass procedure, the reflux (heartburn) disappears.
10. There is 57% of chance that migraine is relieved or resolved.
11. Non-alcoholic liver steatosis or fatty liver is improved or resolved in 90% of patients.
12. Polycystic ovarian syndrome symptoms are reduced and the menstrual cycle will be more regular in 78% of patients.
13. Increased fertility for men and women.
14. In the case of female infertility, the probability of natural and medically assisted conception will increase.
15. Back and joint problems will be alleviated.

In conclusion, even though there are risks involved in bariatric surgery, they are minimal compared to living life as an overweight person prone to different health risks. There is little to lose and a lot to gain in the forms of better health, increased energy and boosted confidence.

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