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 weight loss 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 bariatric surgery.
This isn’t a problem the first few weeks, because the incision is sore and will remind weight loss surgery 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 doctor will have to fix that hernia.
Hernias develop in about 20 percent of weight loss surgeries
Every weight loss surgeon has his favorite suture and method of closing the wound. Again—don’t make your doctor 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 weight loss surgeries, whether you have an open or laparoscopic operation. Hernias need to be repaired. Hernia operations aren’t too much fun, but the newer techniques with mesh have made it an outpatient event. Some bariatric surgery 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 an operation, 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. Weight loss 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 weight loss surgery causes fewer adhesions than an open procedure, adhesions can still occur. A bowel obstruction typically occurs within the first year of an operation— but not always. One of my favorite weight loss surgery 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 RNY bypass surgery
In RNY gastric bypass weight loss surgery, 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 weight loss 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 bariatric surgery 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 bariatric surgery patients develop gallstones during the weight loss, which is why some weight loss surgeons remove the gallbladder as a matter of routine. Some bariatric 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 bariatric surgery patients. Again, if your bariatric 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.