Risks, complications, and adverse events you need to know about.
All surgical procedures have risks. When you decide on a procedure, you should know what the risks are. Talk with your surgeon in detail about all the risks and complications that might arise. Then you will have the information you need to make a decision.
What are the general risks?
The adjustable gastric band procedure includes the same risks that come with all major surgeries. There are also added risks in any operation for patients who are seriously overweight. You should know that death is one of the risks. It can occur any time during the operation. It can also occur as a result of the operation. Death can occur despite all the precautions that are taken. There is a risk of gastric perforation (a tear in the stomach wall) during or after the procedure that might lead to the need for another surgery. In the U.S. clinical study this happened in 1% of the patients. There were no deaths during or immediately after surgery in the U.S. study. Your age can increase your risk from surgery. So can excess weight. Certain diseases, whether they were caused by obesity or not, can increase your risk from surgery. There are also risks that come with the medications and the methods used in the surgical procedure. You also have risks that come from how your body responds to any foreign object implanted in it. Published results from past surgeries, however, do show that LAP-BAND System surgery may have fewer risks than other surgical treatments for obesity.
What are the specific risks and possible complications?
Talk to your doctor about all of the following risks and complications:
ulceration
gastritis (irritated stomach tissue)
gastroesophageal reflux (regurgitation)
heartburn
gas bloat
dysphagia (difficulty swallowing)
dehydration
constipation
weight regain
death
Laparoscopic surgery has its own set of possible problems. They include:
spleen or liver damage (sometimes requiring spleen removal)
damage to major blood vessels
lung problems
thrombosis (blood clots)
rupture of the wound
perforation of the stomach or esophagus during surgery
Laparoscopic surgery is not always possible. The surgeon may need to switch to an "open" method due to some of the reasons mentioned here. This happened in about 5% of the cases in the U.S. Clinical Study.
There are also problems that can occur that are directly related to the adjustable gastric band:
The band can spontaneously deflate because of leakage. That leakage can come from the band, the reservoir, or the tubing that connects them.
The band can slip.
There can be stomach slippage.
The stomach pouch can enlarge.
The stoma (stomach outlet) can be blocked.
The band can erode into the stomach.
Obstruction of the stoma can be caused by:
food
swelling
improper placement of the band
the band being over-inflated
band or stomach slippage
stomach pouch twisting
stomach pouch enlargement
There have been some reports that the esophagus has stretched or dilated in some patients. This could be caused by:
improper placement of the band
the band being tightened too much
stoma obstruction
binge eating
excessive vomiting
Patients who have a weaker esophagus may be more likely to have this problem. A weaker esophagus is one that is not good at pushing food through. Tell your surgeon if you have difficulty swallowing. Then your surgeon can evaluate this.
Weight loss with the adjustable gastric band is typically slower and more gradual than with some other weight-loss surgeries. Tightening the band too fast or too much to try to speed up weight loss should be avoided. The stomach pouch and/or esophagus can become enlarged as a result. You need to learn how to use your band as a tool that can help you reduce the amount you eat.
Infection is possible. Also, the band can erode into the stomach. This can happen right after surgery or years later, although this rarely happens.
Complications can cause reduced weight loss. They can also cause weight gain. Other complications can result that require more surgery to remove, reposition, or replace the band.
Some patients have more nausea and vomiting than others. You should see your physician at once if vomiting persists. Rapid weight loss may lead to symptoms of:
malnutrition
anemia
related complications
It is possible you may not lose much weight or any weight at all. You could also have complications related to obesity.
If any complications occur, you may need to stay in the hospital longer. You may also need to return to the hospital later. A number of less serious complications can also occur. These may have little effect on how long it takes you to recover from surgery.
If you have existing problems, such as diabetes, a large hiatal hernia (part of the stomach in the chest cavity), Barrett's esophagus (severe, chronic inflammation of the lower esophagus), or emotional or psychological problems, you may have more complications. Your surgeon will consider how bad your symptoms are, and if you are a good candidate for the adjustable gastric band surgery. You also have more risk of complications if you've had a surgery before in the same area. If the procedure is not done laparoscopically by an experienced surgeon, you may have more risk of complications.
Anti-inflammatory drugs that may irritate the stomach, such as aspirin and NSAIDs, should be used with caution.
Some people need folate and vitamin B12 supplements to maintain normal homocycteine levels. Elevated homocycteine levels can increase risks to your heart and the risk of spinal birth defects.
You can develop gallstones after a rapid weight loss. This can make it necessary to remove your gallbladder.
Removing the band
If the adjustable gastric band has been placed laparoscopically, it may be possible to remove it the same way. However, an "open" procedure may be necessary to remove a band. In the U.S. Clinical Study, 60% of the bands that were removed were done laparoscopically. Surgeons report that after the band is removed, the stomach returns to essentially a normal state.
At this time, there are no known reasons to suggest that the band should be replaced or removed at some point unless a complication occurs or you do not lose weight. It is difficult, though, to say whether the band will stay in place for the rest of your life. It may need to be removed or replaced at some point. Removing the device requires a surgical procedure. That procedure will have all the related risks and possible complications that come with surgery. The risk of some complications, such as erosions and infection, increase with any added procedure.
