Gastric Bypass Surgery Riskiest For Those Who Need It Most

December 2003 - A study of 335 gastric bypass surgery patients at University Hospitals of Cleveland is being highlighted by the Radiological Society of North America (RSNA) as an important warning for people considering the procedure: Physicians report important risks associated with surgery on the morbidly obese, and urge potential patients to seek care from physicians and staff with significant surgical experience and gastric bypass programs involving comprehensive post-surgical follow-up.

The annual meeting of the RSNA featured a study authored by Elmar Merkle, MD, radiologist, and Thomas Stellato, MD, surgeon and founder of the bariatric program at University Hospitals of Cleveland. Dr. Merkle, who is currently associate professor in the department of radiology at Duke University Medical Center in Durham, N.C., presented the findings, which concluded that the same health risks that make morbidly obese patients eligible for gastric bypass surgery also leave them susceptible to complications during and after the surgery.

Radiologic imaging following 335 Roux-en-Y gastric bypass surgeries helped identify 57 complications from surgery, including suture tears and leaks, pulmonary embolism, pneumonia and infection.

Gastric bypass surgery involves stapling the upper stomach to create a small pouch that is then attached to the small intestine, reducing the capacity of the stomach. "This should not be considered a cosmetic procedure," said Elmar Merkle, M.D., the lead author.

"People need to be aware of the potential complications of this surgery. It basically should be the last option we can offer the morbidly obese, after other less invasive interventions such as diet and exercise have been tried."

Surgeon Thomas Stellato agrees: "Many media stars have popularized this surgery which, for the right patient, is a true life-saver. However, surgery like this must never be taken lightly. The more than 500 patients who underwent surgery at UHC were very carefully selected and very closely monitored following surgery. Our program has one of the lowest mortality and complications rates in the country.and yet we are very aware of the risks involved. We hope this report serves to educate both physicians and patients seeking this kind of surgery." Dr. Stellato is also the Charles A. Hubay M.D. Professor of Surgery at UHC and Case Western Reserve School of Medicine.

The number of gastrointestinal surgeries for weight loss is soaring, according to the American Society for Bariatric Surgery, which estimates that the 63,000 procedures performed in 2002 will increase to 100,000 this year. Americans who are at least 100 pounds overweight are eligible for gastrointestinal surgery, according to National Institutes of Health (NIH) guidelines, but a patient who is less than 100 pounds overweight may also be considered if there is a life-threatening condition related to his or her obesity, such as type 2 diabetes or cardiopulmonary problems.

In the UHC study of 335 patients, there were eight reports of anastomotic leaks and five instances of staple line disruption in the stomach, complications specific to Roux-en-Y. Three incidents of pulmonary embolism, two cases of pneumonia, and single cases of severe infection and open abdominal wound disruption were also reported complications that are more prevalent among severely overweight patients undergoing surgery. Two patients died within 30 days of surgery from complications associated with morbid obesity and surgery; since the study was completed another 200 patients have undergone gastric bypass at UHC with no associated deaths.

"Gastric bypass surgery is not about losing weight the easy way and looking good the operation is about improving health," Dr. Merkle said. "There should be a long-term commitment by the patient. Eating habits must change. For example, patients will need lifelong vitamin supplements. Some patients lose weight, then gain it back again. Not everyone gets the results they want, but they all face the risk of these complications."

Co-authors of the study included Cathleen Crouse, R.N., the coordinator of the bariatric program at UHC; Peter T. Hallowell, M.D., who performed part of the operations; and Dean Akira Nakamoto, M.D., the director of body imaging at UHC.

Source: University Hospitals of Cleveland