Complex Surgery Events

  

Bariatric Surgery involves various degrees of complexity, though largely depends on a patient’s medical history and level of obesity.  Through many years of experience, and over 3500 surgical interventions, BSG has come to specialize in not only regular bariatric surgery procedures, but also in the most complex and complicated of cases:

Gastric Bypass Surgery Room

Previous Bariatric Surgery

Bariatric Support Group has developed a reputation for excellence and we have remedied hundreds of cases that have already been through prior bariatric procedures (either laparoscopic or standard open surgery) with results other than anticipated, such as stagnation of weight loss, weight gain or a significant change in the quality of life, despite adequate weight loss. Please refer to the illustrations below to learn of how BSG has corrected various cases that would have otherwise been detrimental situations.

- Failure of the Adjustable Gastric Band

Most common complications for patients who have had an adjustable gastric band are: stagnation of weight reduction, weight gain, misplacement or migration of the band, gastric penetration of the band, esophageal dilatation and gastro-esophageal reflux, persistent vomiting, or dependence on the treating physician. The ideal solution in these cases is removal of the band and conversion to a gastric bypass.

When the band has penetrated the stomach, two separate surgical interventions are advised: the first one is to remove the band (in some of patients this can be done through a gastroscopy) and the second one is the gastric bypass. At present we have performed more than 120 conversions of this nature. The operating time is approximately three hours, the complication rate is below 1% and the recovery has been uneventful.

- Vertical Gastroplasty failure or un-cut Gastroplasty

Technically a less complex procedure when compared to conversion of the gastric band. In most cases it is possible to perform a laparoscopic Gastric Bypass. Surgery times are similar to the situation above and the likelihood for complications falls below 1%.

- Sleeve Gastrectomy Failure

Symptoms are: stagnation in weight reduction, weight gain, severe gastro-esophageal reflux, and peptic esophageal injury.  It may be converted to a laparoscopic Gastric Bypass or the Sleeve may be re-calibrated through laparoscopy (most common reason for failure is dilatation of the gastric pouch) provided the patient does not experience associated reflux.

- Failure in Gastric Bypass

Evidenced by stagnation in weight loss, weight gain, deterioration of the quality of life or deterioration of the quality of health of the patient.

Thorough endoscopic and image studies of the patient are to be performed in order to assess the pertinent correction. Intervention is then performed by laparoscopy, which consists in the construction of an adequate gastric pouch, calibration of the gastro-jejunal junction and the construction of an intestinal limb of adequate length. Duration of the procedure depends on the nature of the correction to be undertaken.

Prior Non-Bariatric Abdominal Surgery

The complexity of the procedure is largely dependent on the number of adhesions that are found and on the nature of the operations previously performed on the digestive tube (such as gastrectomy, anti-reflux surgery, etc.), as well as on any surgery of the abdominal wall like ventral hernia repair with mesh or dermolipectomy with plication of the anterior abdominal muscles. In any case, the surgeon should be very cautious entering the abdominal cavity to avoid injuring any structure. In patients with previous abdominal wall surgery the surgical field might be reduced due to the rigidity of the abdominal wall.

The above factors could prolong the surgical time but there are no contra-indications to perform the operation thru laparoscopic approach. The percentage of resulting complications is in no way different from those in patients with no prior surgery. Obviously this depends on the expertise and experience of the surgical team.

Severe Central Obesity

The largest the abdominal perimeter of the patient, surgery is more difficult specially entering the abdomen due to the thickness of the wall. The amount of the intra-abdominal fat and the fatty infiltration of the liver make surgery more complex. The fatty liver might progress to cirrhosis. We have operated on patients with established cirrhosis improving the prognosis of this condition and the quality of life of the patient.

The success of the procedure depends on the experience of the surgical team and the availability of contemporary technology.  Both necessities are available with the expertise of Bariatric Support Group

Severe Associated Illness

Obesity is regularly associated to a significant number of medical conditions: type II Diabetes Mellitus, arterial hypertension, hyperlypidemia, fatty infiltration of the liver or cirrhosis, obstructive sleep apnea, etc. Many patients have severe health problems with high surgical risk as a result of the associated cardiopulmonary or metabolic pathology. The preoperative evaluation and preparation of these patients is very important for the success of the intervention. The surgical time is critical: the shorter the procedure, the highest possibility of success (Our surgical time for a gastric bypass is about one hour).

In patients with severe cardio-pulmonary or metabolic conditions, the post anesthesia recovery and follow up should be considered in an Intensive Care Unit. Usually, the recovery time in our ICU is very short.

For patients with medical or metabolic associated conditions, the first surgical choice is the Gastric Bypass. With this procedure, over 90% of diabetic II patients, up to 70 % of hypertensive and 70% of hiperlypidemic patients are cured.

Bariatric Support Group would like to emphasize that the experience and expertise of our surgical team allows us proper management of many obesity related pathologies and has placed us in the leadership position for surgical correction of prior bariatric procedures. We provide successful short and long term results and an improved quality of life and well being for our patients.

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