The extent of bariatric surgery’s risk of weight loss may depend on the surgeon’s skill.
After sleeve gastrectomy and Roux-en-Y gastric bypass, the third most common bariatric procedure is a revision to correct a previous bariatric procedure, as you can see below and at 0:16 in my video. Complications of Weight Loss Surgery.
Up to 25% of patients have to return to the operating room due to complications from their first surgery. Reoperation is even more dangerous, with a 10-fold higher mortality rate, and “there is no guarantee of success.” Complications include leaks, fistulas, ulcers, strictures, erosions, obstructions, and severe acid reflux.
The level of risk may depend on the skill of the surgeon. In a study published in New England Journal of Medicinebariatric surgeons voluntarily submitted videos of their surgeries to a panel of their peers for evaluation. Technical characteristics varied widely and were associated with rates of complications, rehospitalization, reoperation, and mortality. Patients operated on by less skilled surgeons experienced three times the complications and five times the death rate.
“Like musicians or athletes, some surgeons may simply be more skilled than others”—but practice may make perfect. Gastric bypass is such a complex procedure that the learning curve may require 500 cases for a surgeon to master the procedure. The risk of complications appears to plateau after about 500 cases, with the lowest risk found among surgeons who have performed more than 600 bypasses. The odds of failure are about double under the knife for those who scored below 75 compared to above 450, as seen below and 1:47 in mine. video.
Therefore, if you choose surgery, I would recommend that you ask your doctor how many procedures they have performed, and to choose an accredited bariatric “Center of Beauty”, where the mortality rate from surgery appears to be two to three times lower than non-accredited centers.
However, it is not always the surgeon’s fault. In a report titled “Dangers of Broccoli,” a surgeon described a case where a woman went to an omnivorous restaurant three months after gastric bypass surgery. She chose really healthy food—good for her!—but apparently she forgot to chew. His basic supplies exploded, and he ended up in the emergency room, then the operating room. They opened him up and found “full bunches of broccoli, lima beans, and other green leafy vegetables” inside his stomach. A caveat to be sure, but perhaps less so is chewing food better after surgery than chewing food better before surgery—keeping all your internal organs strong.
Even if the surgical procedure goes well, nutritional changes and vigilance are necessary to avoid vitamin and mineral deficiencies. We are talking about more than anemia, osteoporosis, or hair loss. Such a deficiency can cause severe cases of life-threatening deficiency, such as beriberi, pellagra, kwashiorkor, and nerve damage that may manifest as vision loss years or even decades after surgery in the case of copper deficiency. Sadly, in reported cases of severe deficiency of the B vitamin called thiamine, about one in three patients progressed to permanent brain damage before the condition was caught.
Malabsorption of nutrients is a target for procedures such as gastric bypass. By cutting out parts of the intestine, you can effectively interfere with the absorption of calories—at the cost of interfering with the absorption of necessary nutrients. Even people who have recently undergone restrictive procedures such as gastric bypass surgery can be at risk of life-threatening nutrient deficiencies due to chronic vomiting. Vomiting is reported in up to 60% of patients after bariatric surgery due to “inappropriate eating behavior.” (In other words, trying to eat normally.) Purging helps with weight loss, similar to how an alcoholic drug called Antabuse can be used to get so violently sick after drinking that they finally learn their lesson.
“Dumping syndrome” can work the same way. A large percentage of gastric bypass patients may suffer from stomach pain, diarrhea, nausea, bloating, fatigue, or heart palpitations after eating high-calorie foods, as they bypass your stomach and dump directly into your intestines. As the surgeons explain, this is a feature, not a bug: “Dumping syndrome is an expected and desired part of the behavioral changes caused by gastric bypass surgery; it can prevent patients from eating heavy meals.”
Doctor’s Note
This is the second in a four-part series about bariatric surgery. If you missed the first one, here you go Mortality Rate of Bariatric Surgery for Weight Loss.
Next: Bariatric Surgery vs. Foods to Reverse Diabetes again How Sustainable Is Weight Loss After Bariatric Surgery?.
My book How not to eat focuses only on sustainable weight loss. Check it out at your local library, or pick it up wherever you get your books. (All proceeds from my books are donated to charities.)
