Gastric Bypass Surgery/Roux-en -Y Gastric Bypass Surgery/Stomach Stapling
Gastric bypass surgery is a popular procedure to produce significant weight loss for the morbidly obese. The procedure involves bypassing most of the stomach and the duodenum (beginning of the small intestine) and creating a small stomach pouch that is attached directly to the small intestine, producing weight loss by two means:
- Restriction: the small stomach pouch cannot hold much food, thus the patient is unable to consume large quantities; and
- Mal-absorption : by bypassing the duodenum, the absorption of fat and calories is also significantly minimized.
The main types of gastric by-pass surgeries are:
- Open Roux-en-Y (RNY)
- Laparoscopic Roux-en-Y
- Fobi Pouch
- Distal Gastric Bypass
- Biliopancreatic Diversion (BPG)
- BilioPancreatic Diversion with Duodenal Switch
Roux-en-Y Gastric Bypass Surgery, known as "stomach stapling" is also called "RGB", and/or "RNY". It is the most common weight loss surgery in the United States. This procedure is performed either surgically or laparoscopically, through either a large vertical incision in the abdomen (surgical) or a number of smaller incisions for the laparoscopic procedure. The average hospital stay is from two or three night to a full week.
During Roux-en-Y surgery, the stomach is sectioned off by a series of staples, and a new pouch is created from a small portion of the stomach. This pouch severely limits the kind and amount of food as well as the number of calories that can be consumed without making the patient ill. This pouch is then attached to a portion of the small intestine (beyond the duodenum) thus limiting absorption of fat and calories but allowing for the gastric juices in the intestine to still do their job of digesting the food. The surgeon may choose to create a "long-limb" and this procedure is then called a Long-Limbed Roux-en-Y.
For laparoscopic surgery, general anesthesia is used, and the abdominal cavity is pumped full of gas to allow the surgeon to maneuver and see his or her work on the screen. For traditional open surgery, the client is sedated.
Gastric Bypass Surgery Malpractice
Roux-en-Y, and indeed all gastric by pass surgeries, are quite effective for achieving weight loss for the severely and morbidly obese but these surgeries are not without risks and complications. The biggest risk of Roux -en-Y and other gastric bypass surgeries is the inexperience of the surgeon. Gastric bypass is an intricate surgery involving critical organs and systems; however as gastric bypass surgery continues to grow in popularity and more doctors and hospitals want to jump on this lucrative bandwagon, competence issues begin to grow. Some hospitals allow doctors to perform this complicated surgery after training at a single weekend seminar!
Risks, Complications and Symptoms
The risks of surgery may be greater than once thought. The latest data suggest that 20% of weight loss surgery patients suffer some type of complication, with 5% suffering serious problems such as heart attacks and stroke. The death rate in the first 30 days after surgery may be higher than for some types of heart interventions.
Roux -en -Y gastric bypass surgery has a morbidity rate of approximately 2%. Half of those with Roux-en-Y problems will experience immediate complications and death ; another half experience post-operative complications that lead to death within one month of surgery. Twenty-five percent of gastric bypass patients will have some form of post-surgical complication!
When performed carelessly, incorrectly or incompetently - which is an all-too common occurrence these days -- gastric bypass complications can include:
- Leakage of gastrointestinal fluids from the sutures or staple lines, which can cause infection, abscess, peritonitis and death. Indications of leakage include:
- Excessive pain that continues for more than two days following surgery
- Back and shoulder pain
- Excessive urination
- Difficulty breathing
Gastrointestinal leakage is a serous condition that can lead to death and should not be overlooked!
Other serious problems from gastric bypass surgery and roux-en-y surgery include:
- Pulmonary embolism (blood clot in the lungs) and respiratory failure resulting in death.
- Heart attack and other cardiac problems
- Kidney problems
- Blood Clots
- Internal bleeding
- Wound infection
- The necessity of follow-up surgeries to correct problems
Leakage and Embolism
The primary complications from gastric bypass surgery and Roux-en-Y gastric bypass surgery are internal bleeding/leakage, and pulmonary embolism . While leakage issues are more common, pulmonary embolism can be more serious as it is more likely to result in death.
- Bleeding or Leakage of Gastric Fluid - The most common major complication of gastric bypass surgery is bleeding or leakage of gastric (stomach) fluid into the peritoneum (abdominal cavity), which can cause lethal swelling called peritonitis. Timely diagnosis and treatment of peritonitis is essential. Failure to accurately diagnose and treat peritonitis may result in permanent injury or death.
- Pulmonary Embolism - Pulmonary embolism is a blood clot (embolism) that travels to the lungs (pulmonary system). When a blood clot blocks a major pulmonary artery, this causes severe damage to the lung and often results in sudden cardiopulmonary arrest (heart and lung failure) and almost instantaneous death.
Deaths from gastric bypass surgeries are increasing, including those from laparoscopic surgeries . Current statistics indicate that one in every 200-300 patients die and at least 10% have complications. In one hospital alone, seven patients died after gastric bypass surgery.
The exact number of fatalities from Roux-en-Y and other gastric bypass surgeries is hard to pinpoint because often the cause of death will be indicated as heart attack, blood clot, or morbid obesity -- and the connection between the cause of death and the surgery is not made.
"Dumping Syndrome" and Other Complications
Some complications of bypass surgery are a result of the patient's failure to follow dietary guidelines which severely limit portions sugar and fat, and require consistent hydration. These complications include:
- Gastritis (inflammation of the stomach lining);
- Vomiting from eating more than the stomach pouch can hold;
- Iron or vitamin B12 deficiencies which can also lead to anemia;
- Calcium deficiencies which may contribute to the development of osteoporosis;
- "Dumping syndrome" from eating too much or eating the wrong foods, creating nausea, vomitting, diarrhea, bloating, dizziness, and sweating.
Many of these symptoms are preventable by strictly following dietary guidelines after surgery. Medical negligence comes into play here if the doctor fails to properly and completely inform the patient of the radical change required in diet and eating habits, and that for the first few months following surgery, the patient's diet will consist almost entirely of high protein fluids and vitamin supplements.
Bypass Surgery Malpractice Issues
Data from May of 2005 indicates that 145,000 patients nationwide underwent gastric bypass weight loss surgery last year, netting doctors and hospitals billions of dollars in revenue. The popularity of weight loss surgery has shown a ten-fold increase in the last 10-12 years. Bypass surgeries have become a lucrative specialty, and some doctors perform four or five operations a day. Hospital revenue from gastric bypass surgeries are nearing $2 billion dollars with significant increases projected each year. Malpractice issues include the following:
- Inexperienced doctors - According to the American Medical Association, the risk of serious injury or death during and after gastric bypass surgery is much lower when the surgeon has performed at least 100 gastric bypass operations. Incidences of complications have been reported to be almost 200% greater for patients whose surgeons have performed less than 100 gastric bypass operations. The death rate from gastric bypass surgery has been reported to be 300% higher when surgeons have performed less than 100 surgeries. Experienced bariatric surgeons - those who specialize in obesity -- are the best choice for bariatric (weight loss) surgeries.
- Inadequate training: some doctors are performing gastric bypass and Roux-en-Y surgery after taking only a weekend seminar! And hospitals are allowing these surgeries!
- Overtaxed Surgeons - Driven mostly by greed, some surgeons are performing up to five gastric bypass surgeries a day, which is far too many to meet minimal standards of proper care.
- Improperly equipped facilities - Due to the high degree of difficulty of gastric bypass surgery and the unique high-risk nature of operating on the morbidly obese, many top bariatric surgeons believe that gastric bypass surgeries should be performed in facilities that specialize in bariatric surgeries, and are equipped with proper d iagnostic tools, appropriately sized instruments and proper equipment for obese persons in order to minimize risk and maximize the chance of quick and appropriate response.
- Psychological Screening: - Not every morbidly obese person is a good candidate for gastric bypass surgery, websites, brochures, testimonials and high-end marketing campaigns notwithstanding. High-integrity bariatric surgeons agree that an appropriate standard of care requires psychological screening of candidates for gastric bypass surgery, especially in terms of their understanding of the radical eating and lifestyle changes that are required for a successful outcome, and the consequences of failing to make those changes.
- Ignoring or inappropriate response to patient complaints - Delayed response to patient concern or symptoms, especially those indicating gastrointestinal leakage, has resulted in serious damage and death for some patients.
- Failure to educate patients and their families of all the risks associated with Gastric Bypass surgery, warning signs following surgery and consequences of failure to follow post-surgery protocols and instructions.
The most common causes of problems with gastric bypass and Roux -En-Y surgeries are:
- Inexperienced or improperly trained surgeons and
- Failure to diagnose and treat gastric bleeds
Therefore, the risk gastric bypass surgery can be best minimized by choosing a surgeon who has performed at least 200 procedures of the exact kind being performed on the patient. For example, if the surgeon has performed hundreds of surgical bypass procedures, but is relatively new to laparoscopic, find a surgeon whose experience is in laparoscopic Roux-en-Y. This is especially important for laparascopic procedure, where the learning curve is very steep.
Before surgery, be sure you understand the risks and the symptoms of complications, including all the signs of a gastric leak, which can present, in the beginning with mild symptoms, but can quickly turn deadly.
If you or someone you love had Roux-en-Y or other gastric bypass surgery and experienced serious complications, there is good chance that the competence level of the surgeon caused or contributed to the problem.
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