Complications In Bariatric Surgery


The Law Of... getting acceptable care in bariatric surgery

It is well established that obesity is a growing global pandemic and the BBC has now reported that we regularly underestimate our calorie intake. It seems that the number of bariatric surgeries being performed is unlikely to slow anytime soon.

The Law Of... getting acceptable care in bariatric surgery

Senior Associate, Justin Glenister explains the issues with such surgery and why it's important to receive the medical care expected of a competent team of healthcare professionals.

Long-term Obesity Issues

Obesity is linked to dozens of serious medical problems, all of which can be treated and, in most cases, cured by significant, sustained weight loss.

Lifestyle changes alone do not simply involve long-term physical endurance, but a significant psychological commitment. In some cases, pharmaceuticals can be prescribed to aid weight loss, however these usually surmount to limited and unsustainable weight loss and can raise serious safety concerns for long-term use.

Despite the invasiveness, potential complications, often irreversible effects, long term dietary changes, and burden of long-term (often life-long) follow-up care, bariatric surgery has become the procedure of choice for many patients.

Bariatric surgery is also an attractive long-term proposition for our publically funded healthcare services, reducing significant co-morbidities and cancer risks.

Different Surgical Options

The surgical options are typically:

  1. Laparoscopic gastric banding: A 30 minute procedure performed as a day case with a 20% weight loss expected within a year; it is reversible, adjustable, and has a low early operative complication rate.

    It should be noted that a prosthetic device increases the risk of infection and band slippage or erosion brings a 10% long term risk of further surgery.

  2. Laparoscopic gastric bypass: A 60 minute procedure with a 2 day hospital stay and an expectation of 30% weight loss.

    Quick and dramatic weight loss is likely, but early complications can be serious and there is a risk of long term bowel obstruction.

  3. Sleeve gastrectomy: A 45 minute procedure and a 1-2 day hospital stay. Intestinal bypass is avoided and 25% weight loss is to be expected.

    Early complications may be serious and there is, as yet, no data on long term disadvantages.

No matter which option is agreed upon, bariatric surgery is a specialist are that requires particularly diligent care before, during, and long after it has been performed.

Justin comments:

"There is a need for careful consideration of the individual patient and administration of non-surgical options within the selection process for surgery. Psychological support should be initiated, and patients are expected to follow a low-calorie diet, stop smoking, and existing health issues must be addressed before a surgery can take place."

"It is the medical professional's duty to undertake a full, 2 stage consent process – it cannot be a 'tick-box' exercise on the day of surgery - the patient must be counselled about the treatment and made aware of the associated risks in order for them to make a fully informed decision on whether to give their consent to the treatment."

"A defective consent process is a breach of the surgeon's duty of care and, assuming a patient can show that consent would have been withheld had correct information been given, they will have a claim in damages for the suffering and loss they endure as a result of the surgery."

Expect A Specialised Level Of Skill

As a minimum, the standard of surgical skill to be expected is that of the competent surgeon, specialising in that field at that particular time. Even the experienced resection surgeon may not have the requisite skills unless they have formal fellowship training in bariatric surgery and have undergone a minimum number of bariatric procedures before being allowed to operate unsupervised.

In the immediate aftermath of any surgery, bleeds and leaks can be experienced. A failure to diagnose and act quickly may cause:

  • Sepsis
  • Ischaemia
  • Necrosis
  • Revision surgery by way of resection

Revision surgery carries a high complication and increased mortality rate and should only be undertaken in specialised centres by surgeons with extensive experience.

Justin explains:

"There are a large number of providers with minimal emergency cover, a lack of specialist equipment, and a lack of trained nursing staff."

"Even if immediate post-operative recovery goes well, there should be a clear discharge plan to the GP including detailed dietary, nutritional, and any psychological support required."

"Many complications occur as a result of post discharge malnutrition and lack of long term support. Complications can, and do occur years after surgery. I have recently dealt with a case of a delayed diagnosis and treatment of an abdominal obstruction complication which occurred some 3 and a half years after an otherwise successful gastric bypass."

"When admitted to hospital some years later with bowel obstruction, my client's treatment was delayed and, as a result, she suffered resection. In addition to her lost alimentary continuity, severe septic illness, percutaneous gastrostomy tube, fistula, abdominal abscess and the several further surgeries needed to bring all this under control, she had lost the benefit of her bariatric surgery and returned to marked obesity."

"The resection could have been avoided had the level of follow-up care not been of a substandard."

Bariatric surgery demands a specialised, experienced, and multi-disciplinary administration of pre, peri, and post-operative surgical care, as well as long-term dietary and psychological support.

If you have had a bariatric surgery and think a medical professional may have been negligent in their duty to you, you could make a medical negligence claim against them.

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