Lasting complications rare after gastric bypass

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - Gastric bypass surgery has become a popular treatment for severe obesity, but the long-term risks have been unclear. Now, new research suggests that while nearly one in five patients will experience a complication after the surgery, the most problems are easily treated and do not cause permanent disability.

"Only 1 percent of the patients have complications classified as severe or leading to any (even temporary) disability," lead author Dr. Guilherme M. Campos told Reuters Health.

As reported in the Archives of Surgery, Campos and colleagues from the University of California in San Francisco assessed the occurrence of complications in all severely obese patients who underwent open or laparoscopic gastric bypass at their center from January 2003 through December 2006.

Complications were classified as: grade I, which required only a bedside intervention to treat; grade 2, which required a more involved intervention, but caused no lasting disability; grade 3, which resulted in irreversible deficits; and grade 4, which resulted in death.

Of the 404 patients included in the study, 72 had gastric bypass performed with the open approach and 332 had the surgery performed laparoscopically. Seventy-four patients (18.3 percent) experienced a total of 107 complications.

"Our overall rate of complications is similar to that reported by others; however, the rate of severe complications was smaller." Campos suggests that optimal results of gastric bypass are obtained with proper patient selection and care before and after surgery using a multidisciplinary, experienced team, Campos emphasized.

Grade 1 and 2 complications, which were usually wound related, were more likely to occur following open rather than laparoscopic gastric bypass. With the open approach, the rates of these complications hovered around 20 percent, whereas with the laparoscopic approach, they did not exceed 8.4 percent.

Four patients (1 percent) experienced a grade 3 or 4 complication, which occurred with comparable frequency with each surgical approach.

Risk factors for complications included diabetes mellitus, a surgeon with limited experience, and the open approach.

The main message for patients and doctors, Campos said, is that gastric bypass, performed at centers with experienced teams and surgeons and with multidisciplinary care available, "is safe and yields the expected benefits of gastric bypass (including) sustained weight loss along with improvement of obesity-associated diseases," such as diabetes and high blood pressure.

SOURCE: Archives of Surgery, October 2007.