Complications of bariatric surgery are rare
Any surgical intervention has its risks of complications and even mortality. These risks depend on factors such as the surgical team's experience and the severity of obesity-related diseases.
The probability of success of a bariatric operation nowadays, without death, is 99.85% in Centers of Excellence.
The rate of severe complications, which I define as those requiring intervention, whether through clinical treatment or even reoperations, is small, around 1 to 2%. With laparoscopic access, improvement of materials and training of surgical teams, this number is small.
As a rule, complications are related to the quantity and severity of the associated diseases. It is worth noting that the diseases that accompany obesity, such as type 2 diabetes, sleep apnea, among others, reinforce the operative indication and compensate them before surgery is important for lower rates of complications.
The most common complications in bariatric and metabolic procedures are setups leaks (called fistulas) and pulmonary embolism (which is common to many surgeries and more frequent in orthopedic surgeries, for example, than bariatric procedures). The latter is prevented by the use of elastic stockings, mechanical compressors of the lower limbs and use of anticoagulants ("blood thinning" medications). Fistulas generally require reintervention, either by laparoscopy or conventional open surgeries, and recently even by endoscopy in selected cases. Other complications such as digestive bleeding, intra-abdominal and even bowel obstruction are less frequent.
The main complication of fistula is usually early in the first days and patients are usually still hospitalized. The most common signs are shaking, abdominal or left shoulder pain and increased heart rate. These early signs serve as a warning to the medical team to investigate the cause, since they are common to pulmonary embolisms and fistulas. The option of clinical, surgical, or endoscopic treatment will depend on the patient's condition, whether it is having systemic repercussions, such as hypotension and other signs of infection. Bleeding from within the abdominal cavity also occurs during hospitalization and signs of infection. abdominal pain and tachycardia are present, as well as pallor of the mucous membranes and skin if the bleeding is high volume. Already the digestives, those that appear from inside the digestive tube, can be later (7 to 10 days) and if they exteriorize through vomits or feces with blood. These signs should be immediately reported to the attending physician or required to go to the emergency room.
Strengthened when performed by experienced staff, the complications and mortality in bariatric surgery are currently in small numbers and if they occur they should be promptly recognized and treated The advantages of weight loss, remission of severe diseases, and finally increased long-term survival when surgery is correctly indicated are incomparably greater than the low rates of complications and a lower mortality rate than many operations.
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