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When I give seminars to introduce patients to Lap-band weight loss surgery, most patients come with their minds made up that this is what they are going to do. They have all done a bit of research and are anxious to have the surgery—and, in fact, want it quickly. I tell them right away that I am going to “scare the hell out of them.”
Weight Loss Surgery: A Risky Business
Lap-band surgery is just that—it is surgery. The next three sections —Risks of Surgery, Myths of Surgery, and Death of a Patient, are not funny. There is nothing funny about surgery, or the problems that can occur. There are some simple things you can do to minimize risk, but all risks can never be entirely avoided. No matter how experienced or careful your surgeon is, bad things can happen. You may not heal well, your guts might leak, you might have some underlying disease or serious side effects. So, be warned—this next section is the most important section of this book so read it more than once.
You Will Wake Up
—Your greatest fear, “Will I wake up?”
Y
es, you will wake up. I know this is your greatest fear. Every morning I face the fear I will wake up and have to go to work. That’s not the same thing? Okay. The risks of death while under anesthesia are around one in 10,000 patients. You will go to sleep, wake up and your surgery will be done. I love going into the recovery room and telling my patients, “It is all over, you are done, and you survived.” It gets me a smile—or a request for more morphine.
The risks of surgery, any surgery, are real. The better prepared you are for weight loss surgery, the less risks you face. This is an “elective” surgery, it is not an emergency, so if your doctor wants to put off this surgery in order to improve your odds, do it! Common reasons to put off surgery are infections, such as a cold, a urinary tract infection, or an impacted wisdom tooth. So if you develop a fever, get sick, or feel something in your body isn’t quite right, call your surgeon. Putting off surgery for a week or two or even a month is better than spending extra time in the hospital with a problem you could have avoided.
Some Things That Can Go Wrong With Weight Loss Surgery
Pulmonary embolus
The main risk of death from weight loss surgery is the same as with every other abdominal surgery—pulmonary embolus (PE). This is a blood clot which breaks loose and travels from the legs or the pelvis to the lung and lodges there. Once there a part of that lung is unable to transfer oxygen to the blood.
This all starts from a blood clot, known as a deep venous thrombosis (DVT). Most DVT happen during the operation. During the operation a patient is still, which can cause their blood to pool in the legs or the pelvis, and surgery tends to make blood coagulate more easily. This can be a good thing, but if it coagulates while in the blood vessel, it can develop into DVT. There is a classic triad, named after the famous Dr. Virchow, called Virchow’s triad. It states that DVT will occur when there is stasis, injury to the vessel, and hypercoagulability. Well, these two occur during every operation.
Surgery causes a hypercoagulable state—that is, a state where blood tends to clot more. Some medical conditions cause patients’ blood tends to clot. These include Leiden’s disease, low levels of protein C or protein S, and some other conditions.
Surgeons do two things that greatly decrease the risk of DVT. First, they give you an injection of either heparin or a low-molecular weight heparin to keep the blood a bit on the “thin” side. If it is too thin it won’t clot, and during surgery you want your blood to clot some. You will also wear some sequential compression stockings on your legs. These stockings have little air activated pumps which pump up like a roller. You will probably wear these stockings after surgery while you are resting. These stockings work in two ways. The first is obvious— they keep the blood from pooling too much. However, they really work by a more complicated mechanism, one that keeps the blood a bit thin.
The operating room is the most common place that these clots happen. The second most common place is after surgery while the patient is recovering. What can be done about that? Well, blood thinners help, but this isThe more you walk, the less likely the blood will pool in your legs or your pelvis. where you can help yourself—a lot. WALK. Walk, walk, walk, walk, and when you are done walking, walk some more. The more you walk, the less likely the blood will pool in your legs or your pelvis. Walking has a lot of other benefits—you will feel better, you will recover faster, your body—especially your guts, will wake up sooner. I always tell my patients that I expect they will walk from the recovery room to their hospital room (in our hospital that is usually from the 2nd floor to the 7th floor). I haven’t had anyone take me up on that offer yet.
As a final measure, a filter—or Inferior Vena Cava Filter (IVC filter), can be used to prevent blood clots from doing damage. These look something like a birdie from a badminton game. This sits in the main vein that returns blood to the heart, and this wire mesh catches large clots before they can go to the lung. This, however, is not for everyone, as with all medical procedures, there is a risk involved with this procedure, so it is something you should talk with your surgeon about. Mainly, this procedure is used for patients who cannot be given certain drugs to thin their blood, or who have had pulmonary emboli in the past while on blood thinners. The filter is not 100 percent effective, and if a patient throws a lot of small clots it probably won’t help, but for certain patients this is an appropriate measure.
Deep Venous Thrombosis
—or blood clot in the leg
This happens to a number of patients, and is the forerunner to a pulmonary embolus. If patients develop a blood clot, we place them on blood thinning medication for months, and require them to wear thick stockings to prevent further problems. These blood clots can cause chronic leg swelling, painful legs, ulcerations, and other nasty things. So, when your surgeon tells you to get up and walk, get up and walk!
Heart attacks During Lap-band Weight Loss Surgery
Some patients have heart disease, which in spite of the EKG or other tests, doesn’t manifest itself until you have surgery. Heart attacks that happen after surgery carry a higher rate of death than those that happen outside of the operating room. So, if your surgeon wants you to have a stress test—don’t stress, get it done! Remember, heart beats gut (paper over rock) and if they find out you do have some heart disease, far better to get that taken care of before surgery than to have a heart attack during surgery.
