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Complications
Complications As always with surgery, there is a risk of complications.
We cannot give a complete list of them but it is important to outline the main ones.
First it is important to know that the risk of complications is that much higher when certain conditions are present, particularly :
- diabetes
- cardiovascular disease
- smoking
- extreme obesity : patients who are super obese : BMI > 50 ).
- previous abdominal surgery and in particular the stomach.
Generally, from our experience, the risk of complications is 4 to 5% for patients who have been operated on for the first time.
It rises to 15% with repeated operations, namely patients who were operated on previously for obesity (band gastroplasty, stapling, etc.).
Every complication must be taken seriously, that is why the patient operated on should never hesitate to call us, should anything appear abnormal.
The warning signs are described in a former heading but resumed opposite. You should take note. All complications do not have the same seriousness. The most serious ones are sutural dehiscence and haemorrhage.
Others are more benign, such as abdominal wall abscess or dumping syndrome.
The side effects described in the former heading are not complications but can make life uncomfortable for some time after the operation. | | Risk factors ! Caution !
Fever Vomiting Pain Breathing problems A weeping wound ! Caution ! | | | | | Complications: 1. Sutural dehiscence During all the operations, a number of sutures are put in place.
Despite the quality of the materials used, the systematic checking of all the sutures at the end of the operation and the experience of the team, a suture may develop a leak.
This is a leakage. In order to prevent the consequences of this complication we always place a drain in the abdomen.
Liquid flowing from the digestive canal into the abdominal cavity brings about the formation of an abscess or more often peritonitis.
The clinical signs are fever, abdominal pain, nausea with an increased heart rate (tachycardia)
As soon as liquid appears from one of the scars, examination is imperative. The diagnosis will be made by blood analysis, radiography and scanner.
A course of treatment with antibiotics and a second operation is often necessary. So two solutions are possible: 1. Solution a : If the liquid finds its way through the drain it will not be necessary to operate again but a connection between the perforation of the suture and the drain hole in the skin will be established.
This leak is called a fistula. The treatment of a fistula puts a stop to all oral feeding.
In general, we can place a prosthesis in the digestive canal via gastroscopy in order to bridge the gap. The prosthesis is temporary and enables the reintroduction of food and the patient to be discharged from the hospital. It will be removed after 6 weeks, always via gastroscopy.
1. Solution b : If the drain cannot channel the leak, a second laparoscopic operation will be necessary to treat the abscess; to drain it, and if possible close the perforation, and to place a feeding tube in the digestive canal beyond the leak (gastrotomy or jejunostomy).
Depending on the evolution, a prosthesis might be possible, which takes us to case 1a. The full treatment of a leakage can take several weeks (generally two to three). | | Leakage Sutural dehiscence / fistula Sutural dehiscence / peritonitis PROSTHESIS | | | | | Complications: 2. haemorrhage The second cause of a serious complication is haemorrhage.
During operations, certain tissues are cut and resutured.
As digestive organs rich in blood vessels are involved, the scars can bleed after the surgery.
Here also two cases are possible according to whether the haemorrhage happens inside or outside the digestive tube into the abdominal cavity. 2.a. - the bleeding is inside the digestive canal : this type of haemorrhage results in anaemia (pale, weak, drop in blood pressure) and stools as black as tar (melaena).
In this event, the cauterisation of the respective blood vessel will be carried out via gastroscopy.
The complication might happen in the hospital, or later after discharge, generally within 15 days after the operation. 2.b. - the bleeding is inside the abdomen: This type of haemorrhage is mostly detected during the stay in hospital.
Blood will show up in the drain or other clinical signs will appear (drop of blood pressure, accelerated heart beat, etc.)
In this case, a new laparoscopic operation is necessary to cauterise the respective blood vessel. | | Haemorrhage Intradigestive > gastroscopy Intra-abdominal > surgery | | | | | Complications: 3. Stenosis The term stenosis means "the constriction of a hollow organ".
In bariatric surgery, a stenosis might develop at one of the sutures, due to excess scarring.
With a stenosis, feeding becomes difficult, first for solid food, then even for liquids.
The warning signs are the progressive appearance of difficult and painful swallowing (dysphagia). This means that the surgeon has to be consulted as soon as the signs appear.
In no event should you wait until excessive weight loss or dehydration occurs (dry mouth, intense feeling of thirst, etc.).
The diagnosis can be made through radiography of the digestive canal. Generally, this will be treated by dilating the contracted zone through gastroscopy. For such a dilatation, which sometimes has to be repeated, a light general anaesthetic is required. | | Stenosis Stenosis > dilatation through endoscopy | | | | |
Complications: 4. Intestinal obstruction As always with operations of the abdomen, the patient might develop adhesions that can lead to complications with intestinal obstruction.
The obstruction would become apparent most of the time by painful cramps, vomiting or a total incapacity to eat, and the intestinal transit comes to a stop (constipation and inability to pass wind).
Here also fast medical attention and treatment is necessary. Often a new operation will be the only therapeutic solution. | | Obstruction
New operation | | | | | Complications: 5. Several less serious complications Amongst these, we point out: - abdominal wall abscess: festering on the surface of one of the scars (the subcutaneous fat of the abdominal wall has a weak defence against infection) - thrombophlebitis: might appear despite pre-operative prevention (Fraxiparine*) - urinary tract infection : might result from the catheter placed for the operation - possible neurological disorders: these are connected to nerve compression on the operating table.
(Despite all our precautions, being overweight might compress a nerve in the upper or lower limbs; these injuries are reversible but might be a hindrance for several weeks or months after the operation) | | Other complications |
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