Bariatric Surgery Complications: A Survey Follow Up
With commentary by Sigrid Bjerge Gribsholt, MD, lead researcher department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Gastric bypass surgery for obese individuals can greatly improve a patient’s quality of life and reduce type 2 diabetes symptoms, but the surgery also comes with risks of complications and symptoms. In a new study, published in JAMA Surgery, researchers from Denmark looked at the incidence of the most common post-surgery problems, and what factors may put patients more at risk.
The researchers suspected that symptoms and complications after gastric bypass were more common than expected, and that the symptoms took a physical and emotional toll on patients. They wanted to examine the burden of common symptoms after Roux-en-Y gastric bypass surgery (RYGB), the widely used type of gastric bypass surgery, as well as what factors might predict who would have complications.
The study examined records of 1,429 patients who had RYGB surgery and who responded to a survey, as well as a control group of 89 morbidly obese individuals who did not have any bariatric surgery. The median time between the surgery and filling out the survey was 4.7 years, and researchers did not ask whether the symptoms occurred immediately after the surgery or years later. The good news is that 87 percent of patients said that they felt better after the surgery. Yet, 89 percent of those who had surgery reported having one or more symptoms, compared to 79 percent in the control group. Mild symptoms are common in patients with obesity, said the study authors.
Slightly more than half of patients experienced fatigue, abdominal pain, and dumping (when food moves from the stomach to the intestine too quickly). Other common symptoms include anemia, gastrointestinal symptoms, hypoglycemia, kidney stones, gallstones and neurological symptoms like peripheral neuropathy.
Approximately two-thirds of patients said they contacted a health care professional because of a symptom, versus about one third of those in the control group, which may indicate that symptoms were severe enough to seek help, the authors say. “The numbers of complications are higher than generally published,” says Sigrid Bjerge Gribsholt, MD, the lead researcher.
In addition, 29 percent had been hospitalized because of symptoms, including for gallstones, a common consequence of severe weight loss of any type.
Yet, despite symptoms, most people felt better and reported a better quality of life. Only about 8 percent reported feeling worse after surgery, and they tended to have multiple symptoms. The authors suggested that doctors should focus on quality of life issues, and even do a depression screening, in patients with multiple symptoms.
The study also found several factors that predicted symptoms: younger age, being female, smoking, and unemployment.
“We suggest that future research should focus on development of weight loss procedures with fewer complications,” says Gribsholt. However, Miguel Burch, MD, director of minimally invasive surgery and bariatric fellowship program at Cedars-Sinai Medical Center, Los Angeles, who was not involved with the study, disagrees. “It is important to remember that bariatric surgery has been shown again and again in long-term, well-controlled studies to decrease overall mortality by at least 24 percent—in this context the development of new weight loss treatments is going in the wrong direction.”
The physicians agree that there should be more focus on educating healthcare providers and patients about potential complications so symptoms can be diagnosed and treated at the earliest stage possible.
“Morbid obesity is a serious health issue that takes time and constant care to resolve,” says Dr. Burch. “It’s not just about losing the weight, it’s about recovering from morbid obesity, and this recovery can be taxing.”