Overview of Postoperative Assessment and Management of Obesity Surgery
With rising obesity rates worldwide, weight loss surgeries are becoming increasingly popular. These surgeries not only help to tackle obesity-related health problems, but they also significantly improve the quality of life and life expectancy of patients.
However, the care for patients who have undergone weight loss surgery doesn’t stop with the surgery itself. These patients need ongoing care and attention from a team of healthcare experts, including nutritionists, psychiatrists, internal medicine specialists, and surgeons. This topic will cover the different types of weight loss surgery, the expected benefits such as weight loss and improvement of the related health issues, the changes that patients need to make in their diet and eating habits, the potential risks, and how the surgery and the following weight loss can psychologically impact patients.
How is Postoperative Assessment and Management of Obesity Surgery performed
When it comes to losing weight, there are usually two paths. The first one involves making lifestyle changes like exercising more and eating healthier. While these changes may help drop some weight in the short run, it can be tough to stick to these habits. The second way involves a medical procedure, which tends to show more promising, long-lasting results. Medical professionals often recommend weight loss surgery, also known as bariatric surgery, to those with a Body Mass Index (BMI) of 40 or more, or a BMI of 35 or more if they have health problems related to their weight.
Weight Loss Treatment Through Surgery
There are different types of weight loss surgeries. Some methods work by reducing how much food your stomach can absorb. Others limit how much food you can eat before feeling full. The most common surgical procedures include the Adjustable Gastric Band (AGB), Sleeve Gastrectomy (SG), Roux-en-y Gastric Bypass (RYGB), and Biliopancreatic Diversion (BPD), also known as Duodenal Switch (DS).
AGB is usually performed with a tiny camera and instruments inserted through small cuts in your belly. The surgeon places a band around the upper part of your stomach to create a small pouch. This pouch can hold less food, which makes you feel full faster. The band adjustment is under your skin and can be tightened or loosened over time to change how much you can eat. Some people like this surgery because there are no changes to your intestines and it has a low rate of complications.
SG is another method in which the surgeon removes about 80% of your stomach. This leaves you with a long, tube-like pouch. This smaller stomach cannot hold as much food. It also produces fewer hunger-causing hormones. This operation is done using small incisions and tends to have fewer complications.
Roux-en-y Gastric Bypass (RYGB) is a commonly performed weight loss surgery. In this, the surgeon creates a small pouch at the top of your stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of your stomach.
The Biliopancreatic Diversion (BPD) or Duodenal Switch (DS) is less common but helps achieve greater weight loss. This procedure involves removing a large part of the stomach and bypassing a length of intestines. However, it’s also associated with higher risks.
Care After Weight Loss Surgery
Most of these surgeries are performed using small cuts, which means less pain, quicker recovery, and lower risk of complications like blood clots. To further reduce the risk of blood clots, every patient is encouraged to start moving soon after surgery. Doctors might also prescribe medicines to prevent blood clotting.
Right after surgery, you’ll start with a clear liquid diet. If you don’t have complications, you’ll gradually progress to a full liquid diet and then to a regular diet. You’ll have frequent medical follow-ups first, and then after the first few months, you will have check-ups every six months for two years, and then once a year. Regular exercise is advised once you recover from surgery, as it helps prevent weight regain, and promotes overall wellness.
Possible Complications of Postoperative Assessment and Management of Obesity Surgery
Even with the best surgical methods and care after surgery, doctors and surgeons still need to closely watch patients who have had weight-loss surgery. They need to look for any issues and treat them properly. Across all types of weight-loss surgeries, the risk of death within 30 days is less than one percent. However, around 4% of patients might experience serious complications. This risk is higher for people who are very overweight, have a history of blood clots, sleep apnea, or who are unable to walk at least 200 feet before surgery. Elderly patients who smoke and have other health conditions are at a higher risk of complications after surgery.
Common complications from weight-loss surgery can include issues like blood clots, ulcers, gallstones, kidney stones, urinary tract infections, and wound infections. There might also be surgical issues like leaks in the surgical area, bleeding, blockages in the intestines, or narrowing of the joint made by the surgery.
Blood clots can be a serious problem after weight-loss surgery. Risk factors for blood clots can include being very overweight, older than 50, male, a smoker, or having a history of blood clots. Surgeons can reduce the risk by keeping the surgery time under three hours, using less invasive surgical techniques, and taking steps to prevent leaks and the need for additional surgeries. If a blood clot is suspected, such as experiencing rapid heartbeat or shortness of breath, a CT scan should be done right away.
Surgical leaks and bleeding can lead to severe infections, the need for additional surgery, or admission to the intensive care unit (ICU). These leaks can be hard to spot in overweight patients as they might not show typical signs like fever. If a surgical leak is suspected, a CT scan should be done right away. Treatment can include draining the leak, antibiotics, nutrition therapy, and placing a stent across the leak.
Internal hernias, where part of an intestine protrudes through a weak spot in the abdominal wall, can happen in 1% to 3% of weight-loss surgery patients. These are more common as patients start to lose weight. They can cause discomfort after meals, along with nausea or vomiting, or signs of a blockage in the bowel. Treatment often involves surgery to reduce the hernia and close the weak spot.
Narrowing joints (stenosis) and marginal ulcers often show up at the site where the stomach is joined to the small intestine (gastroenteric anastomosis). Stenosis usually occurs more than 30 days after surgery and can create stomach pain and regurgitation. Marginal ulcers can cause stomach pain or vomiting of blood. Both conditions are diagnosed via endoscopy and treated with medications.
Different types of weight-loss surgeries might have specific complications.
Adjustable gastric bands, for example, have the lowest risk of complications. However, they can still cause problems, such as erosion of the band into the stomach wall, issues with the port like infection and movement of the band leading to blockage and enlargement of the food pipe. Treatment typically involves surgery to remove the band and fix the stomach.
In the case of sleeve gastrectomy, overall complication rate is comparatively low. The most concerning complications, other than death (which occurs in 0.5% of cases within 30 days), include surgical leaks and narrowing of the area where the stomach is joined to the small intestine (stenosis).
What Else Should I Know About Postoperative Assessment and Management of Obesity Surgery?
Talk about bariatric surgery and its potential side effects can be quite daunting for patients. However, it is essential to keep in mind that obesity on its own can lead to serious health issues, including heart disease, stroke, sleep apnea, high cholesterol, diabetes, high blood pressure, joint disease, asthma, cancer, and depression. Obesity is a significant health problem worldwide, negatively impacting life expectancy, quality of life, and increasing healthcare expenses.
Bariatric surgery, or weight loss surgery, is the most potent weapon we have in the battle against obesity. It’s proven to greatly reduce or even completely get rid of various health problems that come with obesity, enhancing the patient’s overall health.
Amazingly, patients begin to see a drop in these additional health issues as early as six months following weight loss surgery. Substantially, bariatric surgery leads to an 80% decrease in yearly death rates and a 50% reduction in overall death rates. The risks of having a stroke or heart attack declines, and in about 86% of patients, sleep apnea problems also improve or even disappear.
Regarding cholesterol, over 99% of patients show an improvement after certain types of weight loss surgery (Biliopancreatic Diversion and Duodenal Switch). Also, all patients who undergo weight-loss surgery exhibit decreased levels of “bad” cholesterol and fats in their blood (low-density lipoprotein and triglycerides).
Additionally, recovery from Type 2 Diabetes was noticed, with over 76% of patients experiencing a complete resolution – the improvement was most notable in patients who underwent surgery that makes the body absorb fewer calories (malabsorptive procedures). Lastly, all the patients undergoing weight-loss surgery showed improvements in blood pressure levels, and hypertension (high blood pressure) got under control in nearly 62% of patients.
