Gastric Bypass is a safe and effective procedure with a low rate of potential complications.
Due to recent events in the news and pop culture, we have had some patients awaiting their operative procedures with specific queries regarding incidents of bowel obstruction and their management. We wrote this review to educate our patients and remind them that we are available to answer any questions by contacting us directly.
We were not involved in the case that was in the news. What we do know, is that the patient in question was having pain in their abdomen for several months and was taking pain medication. We also know that this patient died from a bowel obstruction. Unfortunately, taking pain medications without investigation of the cause of the pain can mask symptoms. With any bowel obstruction, time to diagnosis and treatment is of utmost importance, because once the obstruction becomes tight enough, it can stop blood flow and cause the bowel to die. If caught before that point, it can be easily treated with an urgent operation that can be lifesaving.
There are several causes for bowel obstruction. It can occur due to inflammation in the abdomen or due to a hernia that can catch a loop of bowel and pinch it off, it can also occur due to adhesions (scar tissue) that can develop secondary to inflammation or surgical manipulation. Among symptoms of bowel obstruction are abdominal distention, recurrent vomiting and absolute constipation with loss of appetite. An imaging study such as an Abdominal X Ray or a simple CT-scan can diagnose the condition or rule it out. That is why we recommend lifelong follow up, instruct our patients to report abdominal pain and see their surgeons immediately.
While in the past abdominal procedures used to be performed with a long incision to gain access to the abdominal contents, in the last 25 years most procedures have been performed with minimal invasive surgical (MIS) techniques including Laparoscopic, Endoscopic and Robotic. These techniques have reduced the adhesion formation and incidents of bowel obstruction remarkably.
To put it into perspective the incidents of bowel obstruction in someone who has had no abdominal surgeries is 300 in 100 000 in the population with that figure doubling in patients who had abdominal surgery.
Surgeons have been performing Gastric Bypass for morbid obesity for the past 65 years and since 2000, it is almost exclusively done by minimally invasive approach. This surgical method proved to be very safe and dramatically increased Gastric Bypass acceptance by patients.
Every major abdominal surgery has some inherent risks and should be performed by highly trained surgeons in a setting of a certified comprehensive bariatric center to minimize risks. Bariatric surgical society and American College of Surgeons run a credentialing and quality assurance program named MBSAQIP that maintains a National database of all bariatric procedures that tracks both short and long-term outcomes. According to this database, immediate postoperative outcomes of bariatric surgery are very good compared to other elective surgical procedures with risk of complications of 2-4% and mortality of 0.1% (predominantly due to medical and not surgical causes). Of an estimated 250,000 bariatric procedures performed in 2022, Gastric Bypass was done in 30% of those cases.
Over the years Gastric Bypass has demonstrated effectiveness with 30-45% total weight loss, low failure rate compared to other bariatric procedures, and was the first therapy to demonstrate that Diabetes can be put in remission. Frequency of long-term side effects (like intestinal obstruction, marginal ulcer and reactive hypoglycemia or severe “dumping syndrome”) are rare and can be effectively treated once detected early. That is why a life-long follow up with your bariatric surgeon is recommended
Incidence of intestinal obstruction after Gastric Bypass is 1-2% and it can develop early or later after the surgery. Effective treatment for this condition is usually operative intervention done with the minimally Invasive technique (small incisions) and expeditious surgery is key to ensure good outcomes.
With Gastric Bypass, surgeons transect the stomach and bowel and their attachment (mesentery) in order to re-configure the GI tract which creates spaces or mesenteric defects that can result in internal herniation causing bowel obstruction after surgery. There are two different schools of thoughts among bariatric surgeons related to the technique of Gastric Bypass formation. One approach is to leave all these mesenteric defects wide open thinking that herniation is infrequent and wide-open space is unlikely to cause bowel strangulation and it can be reduced easily if needed.
Another approach is to close all these mesenteric defects with permanent sutures at the time of Gastric Bypass procedure. Systematic analysis of studies demonstrated that this closure technique both in a long and short-term lower the incidence of internal herniation by 75%, occurrence of small bowel obstruction by 70% and need for reoperation by 72%.
Since the start of our program in 2001, it was our policy to close all these defects systematically in every case. Ascension Saint Agnes Bariatric program surgeons have performed more than 5,000 primary and revision Gastric Bypasses and we can recall only 2 cases when we had to resect small bowel for strangulation and both patients made a full recovery. Being a referral center, we have treated hundreds of patients for intestinal obstruction after Gastric Bypass done at other hospitals.
In conclusion, we believe that Gastric Bypass is a very safe and effective procedure that results in a 50% reduction of all-cause mortality and in increasing life quality years. Studies have shown a remarkable resolution and reduction of risk in over 80 medical conditions and 15 cancers. We also encourage lifelong follow up with your surgeon, and communication of any issues that you are experiencing.
At Ascension Saint Agnes Bariatric Surgery program we are available with an around the clock (24 hours/ 7 days) direct coverage by one of our Specialized, well trained and experienced surgeons to attend to any complication that may arise in a timely and expedient manner.