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Bariatric Surgery

The United States Center for Disease Control and Prevention (CDC) tells us “more than one-third of U.S. adults (over 72 million people) and 17 percent of U.S. children are obese. During 1980-2008, obesity rates doubled for adults and tripled for children.” iFurthermore, the CDC informs us that obesity increases the risk of many health conditions, including the following:

  • Coronary heart disease, stroke and high blood pressure
  • Type 2 diabetes
  • Cancers, such as endometrial, breast and colon cancer
  • High total cholesterol or high levels of triglyceride
  • Liver and gallbladder disease
  • Sleep apnea and respiratory problems
  • Degeneration of cartilage and underlying bone within a joint (osteoarthritis)
  • Reproductive health complications such as infertility
  • Mental health conditions ii

The obesity epidemic has been a topic of discussion for many years. One tool that has been developed to fight obesity is bariatric surgery. According to the University of Iowa Hospital and Clinic‘s website, “The University of Iowa is the birthplace of obesity surgery. Dr. Edward Mason — the ‘father of bariatric surgery’ — conceived and performed the first weight loss procedure at the University of Iowa in 1965.” Since that time, hundreds of thousands of bariatric procedures have been performed in the United States and throughout the world. The American Society for Metabolic & Bariatric Surgery estimates that approximately 200,000 adults have metabolic and bariatric surgery each year, “which is about 1 percent of the surgically eligible population.” iiiIn other words, within the medical profession, bariatric surgery is seen as a growth opportunity.

Despite the growth of bariatric surgery, and presumably continued development of expertise needed to perform such surgeries, significant risks continue to exist for bariatric surgery patients. The risks include both death (mortality) and non-death health risks (morbidity). The operating physician has a duty to manage known risks and to avoid, if possible, these risks from developing. For example, one of the leading causes of early death following bariatric surgery is a pulmonary embolism. Medical science has developed certain prophylactic measures to minimize the development of pulmonary embolism. These prophylactic measures may include pneumatic compression devices as well as subcutaneous unfractionated or low molecular weight heparin injections. A surgeon who performed bariatric surgery on a patient and failed to bring any prophylactic measures in order to minimize the risk of developing a pulmonary embolism would be hard pressed to defend himself from a claim of medical negligence if the patient suddenly died from a pulmonary embolism.

Mortality (Death)

Generally, bariatric surgeons will inform patients that the overall 30-day mortality rate for bariatric surgical procedures is less than 1 percent. However, the mortality rates for certain groups are much higher than this. These groups include patients: over 65, male, patients with chronic disease or the super obese (BMI >50). Additionally, increased mortality is associated with low surgeon and hospital volume of bariatric procedures. “Both in-hospital and 30-day mortality are decreased when bariatric surgery is performed by surgeons and hospitals that perform more than 100 procedures a year.” iv

Intraoperative Complications

Some complications may arise during the bariatric surgery procedure. For example, in laparoscopic bariatric surgery procedures, trocars are inserted into the abdominal cavity. Care must be taken when such instruments are inserted into the body as significant damage may result if done improperly. Indeed, the instructional booklets/pamphlets that accompany these trocars, very often warn the physician of the need to be careful when inserting the trocar. Despite these warnings, physicians sometimes apply excessive pressure when inserting the trocar and unnecessary injuries may result. Injuries can occur to the spleen, portal vein and also to the bowel. Sometimes during a Roux-en-Y procedure the physician fails to maintain proper bowel orientation with the result that misconstruction can occur.

Following surgery significant bleeding may occur which, if not corrected, can lead to further unnecessary complications. Additionally, wound infections and leaks may occur. The use of certain surgical techniques, as well as prescribing appropriate antibiotics, have been shown to decrease the incidence of wound infections. When a leak occurs, certain signs and symptoms, such as low-grade fevers, respiratory compromise or unexplained tachycardia (rapid heartbeat) may be present. Since a leak can rapidly progress to the development of sepsis and/or septic shock, it is important prompt action be taken if a leak is suspected. Failure to take appropriate action if the signs and symptoms of a leak occur may constitute medical negligence.

If you or a loved one is injured as a result of a bariatric surgery procedure, you may wish to have the relevant medical records reviewed by an experienced medical malpractice law firm.

i Id.
ii Adair JD and Ellsmere JC, Complications of Bariatric Surgery, 2013 Up-To-Date (literature current through February 2013) (accessed 3/18/2013)