Weight loss surgery - long term complications

Hernias

A hernia is a weakness in the fascia, or a hole in it, and stuff from the inside begins to find its way out. Fascia is the same thing as gristle—that tough stuff you can’t chew too well. The fascia, and not the muscle, is what we sew together when we close an abdomen. When we sew you together we use suture, which is about a 30 pound test line.

When we sew the abdomen back together the fascia heals slowly—in fact it takes about six weeks for the fascia to be at about sixty percent of the strength it was before surgery. It can tear open, or rip (or some people call it rupture) fairly easily. This is why we tell patients not to lift anything heavier than about fifteen pounds for the first six weeks after surgery.

This isn’t a problem the first few weeks, because the incision is sore and will remind patients not to do anything too strenuous. But usually at about one month, people tend to forget and pick up junior—they sometimes feel a pop and then have a small bulge. The small bulge grows over time, and becomes a bigger bulge, and at some point your surgeon will have to fix that hernia.

Hernias develop in about 20 percent of surgeries

Every surgeon has his favorite suture and method of closing the wound. Again—don’t make your surgeon change what he/she does because you want it done a certain way. He is the expert, and if something works for him (or her), let him do his job.

Hernias develop in about 20 percent of surgeries, whether you have open surgery or laparoscopic surgery. Hernias need to be repaired. Hernia surgery isn’t too much fun, but the newer techniques with mesh have made it an outpatient event. Some patients have a tummy tuck and their hernia repaired at the same time.

Adhesions and bowel obstructions after gastric bypass surgery

—kinking the garden hose

Adhesions are simply scar tissue in the abdomen. After we do surgery, there is always formation of scar tissue. It is normal and natural. If, however, some bowel gets caught in the scar tissue, it can cause a bowel obstruction—which is like a kinking of the garden hose. This will lead to nausea and vomiting, you will stop passing gas from your rectum, and you will not have bowel movements. Or, you will blow up worse than road kill on a Jersey highway. This, fortunately, happens infrequently, but some people are more prone to adhesions than others. Surgeons can insert some material in the abdomen to reduce adhesions, but cannot totally prevent them. Some adhesions will also bind the bowel so that when you turn a certain way, you will wince a bit from the pain. While laparoscopic surgery causes fewer adhesions than open surgery, adhesions can still occur. A bowel obstruction typically occurs within the first year of surgery— but not always. One of my favorite patients was a little lady who had her appendix removed in 1905 in Kansas City. She came in with a bowel obstruction 80 years later, in 1990.

Stoma ulcers and strictures after Roux en Y bypass surgery

In Roux en Y gastric bypass, the area where the small bowel is connected to the upper pouch can develop an ulcer or a stricture. The anastomosis can scar down to pinpoint, causing vomiting of all but some liquids. If this happens, the surgeon calls the friendly neighborhood gastroenterologist who will put a scope down and open up the stricture with a balloon. Typically it takes two to four sessions to open these strictures up.

Sometimes these are caused by an ulcer that develops at the anastomosis. This is one of the reasons we ask patients to always take some acid-reducing agent, such as Pepcid® or Prevacid®. Usually you will need to take this for life.

Gallstones after weight loss surgery

Twenty-five percent of patients develop gallstones during the weight loss, which is why some surgeons remove the gallbladder as a matter of routine. Some surgeons only remove the gallbladder if it appears to be diseased. There is a medicine called Actigall®, which works to decrease that incidence of gallstones in post operative patients. Again, if your surgeon does one thing or the other as a matter of routine, go with what he/she recommends, do not make them change to something he is not comfortable with.

Continue