Weight Loss Surgery: Long-Term Results
Health Problems After Weight Loss Surgery
Whether you have gastric bypass or gastric banding surgery, specific complications are a risk. It’s important that you watch for problems — and see your surgeon right away.
Gastric Bypass Surgery Problems
Nutrition deficiencies. If you have gastric bypass surgery, monitoring your nutrition intake — protein, fluids, vitamins, and minerals — is a critical component in long-term success.
The surgical alterations create a state of malabsorption, which contributes to weight loss. Essentially, it means that the body eliminates calories, fat, vitamins, and minerals in food you eat. To keep the body healthy, those nutrients must be replaced — with vitamin B12, calcium, and iron supplements as well as a multivitamin.
“Vitamins and minerals are medications,” Fernstrom explains. “If you don’t take them, you will have significant deficits — cognitive deficits, anemia, or osteoporosis. There are consequences with not following the lifestyle.”
With gastric banding surgery, there is less risk of serious nutrition deficiencies — as malabsorption is not involved in that surgery. However, there still is the need to eat a healthy, balanced diet. A daily multivitamin is also required.
Malnutrition can be a big problem for some gastric bypass patients. It occurs in rare cases, when the person has lost too much weight, explains Madan. This can be related to surgery, when the connection between the small bowel and the stomach is too small.
“They can only eat very little, even less than the normal four ounces,” he says. “They’re hungry but they can’t eat. They’re vomiting all the time.”
An outpatient procedure easily relieves the problem. It involves a flexible endoscope into the mouth, then a balloon is used to dilate the connection, which relieves the problem.
However, when patients having this problem don’t go and see their doctor, it can develop into severe nutrition, Madan says.
Regaining Weight – or Not Losing Weight. For gastric bypass patients, eating too frequently is a typical problem. Since the pouch restricts how much you eat, it’s difficult to overeat in any one meal.
“A patient may bring lunch to work, eat only a quarter of it at noon, but eat the rest over the afternoon,” says Courcoulas. “They’re eating more calories than they should — just eating them in small amounts.”
Also, the stomach pouch will “give” a little over time, so people can eat a little more several years after surgery — especially if they’re pushing the limit anyway. “Even if they get a fullness sensation pretty quickly, they must learn to tune into it and stop eating,” she says.
Another problem: Over time, the body adapts to the surgical changes — so there is less malabsorption. At that point, lifestyle to maintain your weight loss is key, Courcoulas says.
Madan says there can also be mechanical problems:
- Food may be going into the old stomach, rather than to transitioning through to the intestine. This indicates that the stomach pouch and the stomach have somehow reconnected themselves — what’s known as a fistula. Surgery can correct this problem.
- The connection from the stomach pouch to the small bowel may be too large. This can be corrected in an outpatient procedure. Patients who are two years after surgery — and have lost feeling of satiety after eating — may be candidates for that procedure.