Bariatric surgery is a growth area of surgery both within the NHS and privately. It is, of course, the ultimate in weight loss surgery. The general public views as the solution to continuous dieting, and being able to eat what it likes and being able to stay a size 8 forever.
The reality is different.
Obesity has always been a problem but with increasing socio-economic wealth, those of us who have a propensity for weight gain and over consumption now have the money to fuel the habit. In the UK in 2011, 25% of the population were obese compared to just 8% back in 1983.
The three main types of bariatric surgery – gastric banding, gastric bypass and sleeve gastrectomy – all of which are major operations.
Patients who are morbidly obese have a high risk of complications with their bariatric surgery. However, despite this, the work up to the surgery is, within the NHS at least, a multi-disciplinary approach involving anaesthetists, surgeons, dieticians and psychologists giving rise to a safer surgical procedure than one might expect. The risk of death from bariatric surgery is 0.1% compared to hip replacement surgery of 0.5% and surgery to repair an aortic aneurysm of 5%.
Bariatric Surgery – the risk when surgeons are unregulated
The main problem with bariatric surgery stems from the fact that the operations are frequently carried out within the largely unregulated private “cosmetic surgery” industry. Not all surgeons within that industry are experienced in these particular procedures and this can bring complications arising after surgery,with problems which might not be recognised by an inexperienced surgeon or even a GP.
The need for ongoing health care
The nation’s concept of bariatric surgery is that it is a “quick fix” but it is far from that. The surgery is part of a planned an ongoing process to help the patient lose weight.
A gastric band, for example need to be tightened as the patient loses weight and his or her body gets smaller.
The gastric sleeve procedure which gaining in popularity and starting to take over from the gastric band, is a permenant restrictive procedure. As well as leading to weight loss it seems to have the ability to resolve weight related diabetes.
Gastric bypass surgery is good for patients with severe morbid obesity with the advantages of excellent weight loss and diabetic resolution. The downsides are a higher rate of complication at surgery and the need for the patient to have a lifetime prescription for vitamin B.
Clinical negligence claims?
The question has to be asked, why is bariatric surgery thought to be one of the next growth areas for medical negligence litigation?
The first explanation is that the patients have high expectations. With the requirements for bariatric surgery on the NHS being a BMI of 40+, or 35+ with other life reducing complications and a history of failure of success in any other weight reducing programme, bariatric surgery is a last resort. Images in the press of celebrities with perfect figures bring high expectations and when the result is not as expected, deep disappointment. Most of us will never look like Lily Allen during her recent performance at Glastonbury, with or without surgery!
The pressing need for national standards
There is also a problem with lack of national standards for cosmetic surgery. Bariatric surgery is as serious as the surgery which a patient with stomach or bowel cancer might face, but is carried out by clinics also offering Botox fillers and breast augmentation. For me, that alone, spells potential disaster.
Another problem is that patients do not realise that having bariatric surgery is not just having one operation followed by rapid weight loss. The procedures require monitoring sometimes several times a year over a number of years.
Getting a patient to comply with post-surgery monitoring is particularly difficult in a patient who has had his or her surgery privately. Many popular cosmetic surgery companies offer “fixed price” surgery with prices coming in at approximately £10,000 for the surgery and immediate aftercare. Longer term aftercare is not included in these packages and with private surgeons charging in the region of £200 per out patient’s appointment private patients do not want to pay to be followed up between 3 and 5 times per year.
Private patients, therefore, can develop complications over a period of years which build up until the outcome is a disaster.
Bariatric Surgery Complications?
Whilst the published statistics for complications arising from bariatric surgery are small, the potential complications are extremely serious and can take months to resolve, sometimes without a good recovery.
Complications can also arise outside of the hospital setting. In one case I know of a GP saw a patient 7 days after Gastric bypass surgery thinking that the surgery undertaken was a gastric band. The GP was unaware of the significance of the differences in surgery and failed to refer the patient back to the hospital. The patient, in fact suffered from a gastric leak from the site of the bypass surgery. By the time this was diagnosed she had developed a fistula and required a 2 month stay in ICU. She suffered from permanent symptoms thereafter.
In another case, a very obese man suffered a perforation of his colon during his gastric bypass surgery. This was not picked up at the time of his original surgery and the delay resulted in him having to have an ileostomy for 6 months. Sadly the attempts to reverse the ileostomy were not successful and he required a permanent stoma.
So, the conclusion; choose your procedure and your surgeon carefully, keep up with your aftercare and remember, prevention is always better than cure. If you are reading this whilst drinking your coffee; did you really need that Kit Kat (107 calories)?
With credit to Mr Omar Khan for his case studies and research into the calorific value of Kit Kats!
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