Weight loss surgery: Gastric bypass, laparoscopic gastric band - Essay Example

Weight Loss Surgery: Gastric Bypass, Laparoscopic Gastric Band: Are They Really Helpful Obesity is a chronic disease that is increasing in prevalence and that poses serious risks for development of diabetes mellitus, hypertension, heart disease, gallbladder disease, and even cancer. As a result those who are suffering from this disease would like to get rid of excess weight. Unfortunately, conventional therapies, such as, diet, exercise, life style modification, hormonal therapy, or drug therapy alone or in combination is often a failure. Fortunately, surgical manipulation of the gastrointestinal tract may be useful in certain cases depending on specific clinical criteria or body mass index. The variety of procedures include gastric bypass, gastroplasty, vertical gastric banding, bilopancreatic bypass, or end-to-side gastric bypass. Medical professionals often advise Roux-en-Y gastric bypass for best long-term weight loss surgery. The patient population has long been accepting such surgery as the definitive management of weight gain. The question is how useful really are they Are they associated with any complications Can people die out of such surgery Is there any new disease as a result of such surgery The answers are not at all encouraging. At 6 am on November 15, last year, a patient's mother noticed that her daughter was not responding. Her daughter is a 19 year old overweight woman, but she was fine the evening before. She was sleeping next to her, had food last night. When see saw her in the morning of this incident, she found her to be pale; her nails had an unusual bluish tinge. She was scared, shook her daughter, but it was too late. Her daughter had been dead for 4 hours. She had perhaps passed away in her sleep with a cardiorespiratory failure. A week before her death, this teenager had undergone a gastric banding in a hospital. She was considerably over weight, weighing 190 kg with a 5 feet 9 inch frame. The doctors claim that the surgery is incidental, and death is natural in these cases due to increased incidence of sleep apnea or pulmonary embolism. Although correct statistics are difficult to come by, there are many reports of such 'isolated incidences' throughout the world. A society that is image obsessed, there may be situations where indications of weight loss surgery is violated, and overweight patient and over enthusiastic surgeons may just take a chance leading to calamity. The ignorance of patients has in someway led to a situation where anti-obesity surgery has turned out to be an industry rather than being a therapeutic measure. Not only death, there are other serious complications out of such surgery. Let us take the case of patient Y who was operated with Roux-en-Y procedure that is an open surgery. Due to excessive abdominal wall fat, the surgeons had tremendous difficulty is operating even with the open technique. This patient developed a wound infection after discharge from the hospital where the whole wound gaped way. The patient was readmitted, and after several weeks or hospital stay, the patient ultimately recovered. That is not all, after about 6 months following the surgery, this patient presented with severe abdominal pain and vomiting, specially notable after food. He would throw up anything he would take. The patient was wheeled into the hospital, and the doctor after radiologic studies declared that he had a stomal stenosis, that is, the opening of the intestine has been narrowed. The patient needed a re-operation to mend this off, and following that he has gained the lost weight after the surgery. One might question the benefit; this is rather a surgical exercise. Not only that, the incision through which the surgery is done may serve as the portal for future hernia, called incisional hernia that may portend to further unsuccessful surgery. The most serious series of complications that may result in such surgeries both laparoscopic or open may take the form of inadvertent injury of the spleen, anastomotic leak, pulmonary embolus, or pneumonia. Anastomotic leak is a serious condition when the stitches in the stomach or intestine give way resulting in release of gastric juice or intestinal juice in the abdomen. This itself could lead to peritonitis that is life threatening. Pulmonary embolus or pneumonia can both be dangerous. The other causes that might lead to death are more horrific. They include hemorrhage from stomach or intestine, necrosis of the Roux limb, respiratory failure, sepsis, cardiac arrhythmia, and upper gastrointestinal tract hemorrhage. It is easy to conclude that all of these may lead to death. One may argue that such complications are common after any surgery, so that these complications may be termed incidental, and doctors do warn patients that weight-loss surgeries are not without complications, and it should be done only in cases of the morbidly obese after studying the pros and cons of the risks and benefits. One should not forget that the doctors have another responsibility. While he is in charge, he is supposed to explain the risks of obesity, the risks of the surgery, and the risks of not doing it. In practice most often the risks of surgery are not adequately explained, and the doctor highlights the risks of obesity and the risks of not doing such surgeries. As a result, serious postoperative events like death. It is to be noted that the complication rate during hospital stay is not trivial, and the complication rates post discharge is just not mentioned. These happen at home long after the patient is discharged from the hospital and are usually attributed to other causes than the surgery itself by the surgeons. People go for it since medical treatment of obesity is complex. Even after such surgeries, the patients need to adhere to diet and physical activity, and compliance to such programs is low. Surgical treatment, hence, has become an option, but due to increased rate of complications, the average stay increases, and the insurance is not exactly ready to bear the cost in such situations. Logically, the laparoscopic banding has become almost the management of choice despite limitations of such procedures and complications rates. Apart from the deadly complications, few other complications may spring up, and their rate is not trivial. These complications do not include late complications that may present post discharge, these are more serious and occur over a prolonged period of time. No one can estimate the actual incidence of nutritional effects, such as, iron, calcium, and vitamin deficiencies that may result from permanently restricting stomach volume. This requires a long-term change in eating habits. The patients need to avoid concentrated carbohydrates at the beginning of any meal to avoid rapid gastric emptying. This is difficult to accomplish, and this may turn out to be catastrophic in obese diabetics. There is evidence that increasingly insurance providers are dropping coverage of such procedures mainly due to very high complication rate. To conclude, gastric bypass procedures or gastric volume reduction surgery that had been well publicized and had become a craze is losing popularity, and a sound judgment would be to analyze the controversial procedure in new lights as to how really helpful this procedures are. Over and above that, recent reports of complications and deaths have raised real concerns over the safety of the procedure. It is, therefore, better not to jump on this surgery as a panacea until things further settle down. Read More