Failure to Diagnose and Treat Complications of Bariatric Weight Loss Surgery

In 2008, an estimated 220,000 extremely obese Americans underwent bariatric or weight loss surgery, according to the American Society for Metabolic and Bariatric Surgery.¹ Bariatric surgery has helped many people suffering from morbid obesity to lose weight and improve their general health and wellness. Bariatric surgeries however, are technically demanding to perform and are not without risk. In the wrong hands the outcome can be disastrous. When things go wrong, they can go terribly wrong and the consequences can be dire and lead to lengthy illness, hospitalization and even death. If you or someone you love has suffered injury or death following bariatric surgery, please contract our bariatric - weight loss surgery lawyers.

What is bariatric surgery? 
Bariatric surgery is the term for a number of different operations to help promote weight loss.  Bariatric surgery changes the anatomy of a patient's digestive system to limit the amount of food that can be eaten and digested.  It redirects food to by pass most of the stomach and flow directly into the middle of the small intestine, which limits calorie absorption. Weight loss surgery is performed only on severely overweight people. The body mass index (BMI) is a standard way to define overweight, obesity, and morbid obesity.  A normal BMI is between 18 and 25. Candidates for weight loss surgery must have a BMI that exceeds 40 or a BMI greater than 35 with significant high risk obesity-related diseases such as life threatening cardiopulmonary problems, severe sleep apnea, obesity hypoventilation syndrome and severe diabetes mellitus.²

What are the various bariatric / weight loss surgery procedures?
There are two basic types of weight loss surgery -- restrictive surgeries and malabsorptive/restrictive (by-pass) surgeries. They help with weight loss in different ways. Restrictive surgeries work by physically restricting or reducing the size of the stomach and slowing down digestion. The surgeon creates a small gastric pouch with a narrow outlet that restricts the amount of food that the patient can eat at one time. The smaller the the stomach, the less one can eat. The two restrictive procedures most often performed are vertical banded gastroplasty and laparoscopic adjustable gastric banding.

The second type of weight loss surgery called malabsorptive/restrictive surgeries are more invasive surgeries.  In addition to restricting the size of the stomach, these surgeries bypass a segment of the small intestine making it harder for the body to absorb calories. The Roux-en-Y gastric bypass is the most widely used malabsorptive/restrictive surgery and accounts for 80% of all bariatric procedures performed in the United States.³

Weight loss surgery is a complicated procedure that carries certain risks and complications and it is not for everyone who is seeking to lose weight. Centers that specialize in bariatric surgery often have an experienced team of professionals including surgeons, nurses, dietitians and others to support the patient at each and every step, beginning even before the surgery.  For other patients, the bariatric surgery experience is quite different with only their surgeon to turn to when things go wrong.  Complications and risks can include:

1) Failure to provide appropriate vitamin and nutritional support following bariatric surgery.

While bariatric surgery can improve quality of life and even save lives, it can often lead to nutritional deficiencies that can cause severe health complications including life-threatening neurological conditions. These conditions result from a reduction in food intake and the inability to absorb nutrients following surgery. They can also result from inadequate nutritional supplements being taken postoperatively.⁴ Some of the conditions that have been observed include:

• Peripheral or Polyneuropathy - Peripheral neuropathy or polyneuropathy is nerve damage that causes burning pain, numbness or tingling in hands, feet and other parts of the body. Vitamins E, B6, B12, and B1 (niacin) are essential to healthy nerve function and deficiencies can cause widespread damage to nerve tissue. The development of peripheral neuropathy after bariatric surgery can occur as the result of its absorption site in the jejunum being bypassed and inadequate nutritional supplements after surgery. About 16 percent of people who underwent bariatric surgery developed peripheral neuropathy, according to one study of more than 400 people conducted by the Mayo Clinic.⁵
• Wernicke's encephalopathy/Korsakoff Syndrome - Weight-loss surgery may also cause memory loss and other serious neurological problems in some patients. Wernicke's /Korsakoff syndrome is a degenerative brain disorder caused by the lack of thiamine (vitamin B1). Wernicke's / Korsakoff's syndrome are generally considered to be different stages of the same disorder.  Wernicke's encephalopathy represents the "acute" phase of the disorder, and Korsakoff's syndrome represents the "chronic" phase.  When there is a persistent deficiency of thiamine there will be symptoms of Wernicke's - if not promptly noticed and treated it could develop into Korsakoff syndrome, which can cause permanent neurological damage. The symptoms of Wernicke's/ Korsakoff syndrome are confusion, short-term memory and vision loss and loss of muscle coordination. Without treatment, Wernicke-Korsakoff syndrome gets steadily worse and can be life threatening.⁶
• Other nutritional deficiencies - Besides deficiencies in thiamine, patients undergoing bariatric surgery are at risk for developing deficiencies of B12 and copper, calcium, phosphate, vitamin D, iron, folate, riboflavin, thiamine and vitamins A, E and K, which together or alone may lead to irreversible nerve injury, memory loss and other neurological complications. Patients undergoing bariatric surgery should be monitored carefully for nutritional deficiencies.

2) Failure to timely diagnose perforation or leakage of the bowel connections after anastomosis.

When the surgeon fastens bowel to bowel, or bowel to stomach, the surgical connection is called an anastomosis.  If it does not form a complete seal, and fluid leaks from the bowel it is called an anastamotic leak. This is a serious and potentially fatal complication of bariatric surgery.⁷ Fluid from the gastrointestinal tract, containing bacteria, leaks out into the abdomen and can cause serious infection and abscess formation. Signs of anastomotic leak may include tachycardia, severe abdominal pain, fever, rigors, and hypotension⁸ An anastomotic leak can become deadly if not recognized and treated early. Life-threatening complications from an anastomotic leak include:

• Peritonitis - Peritonitis after bariatric surgery is a serious complication that is usually caused by a anastomotic leak.⁹ Peritonitis is an inflammation of the smooth transparent membrane that lines the cavity of the abdomen and covers the organs within the abdomen. Peritonitis requires prompt medical attention to fight the infection and treat any underlying medical conditions. Treatment of peritonitis usually involves antibiotics and, in some cases, surgery. Left untreated, peritonitis can lead to severe, potentially life-threatening infection throughout the body.¹⁰
• Sepsis - Sepsis is a serious medical condition in which the body is fighting a severe infection that has spread via the bloodstream. The most common cause of sepsis in a bariatric patient is a postoperative leak.¹¹ If a patient becomes "septic," they will likely be in a state of low blood pressure termed “shock.” Septic shock can lead to serious complications that affect the kidneys, lungs, brain, and hearing, and can even cause death. Tachypnea (rapid breathing) or decreasing oxygen in the blood can signal early sepsis from a anastomotic leak.¹²

3) Failure to Diagnose Pulmonary Embolism

Pulmonary embolism is a leading cause of death following bariatric surgery for morbid obesity.¹³ Pulmonary embolism occurs when a blood clot in the leg breaks off and travels to the lungs.  Although these can occur at any time, they are more likely in overweight patients, especially likely at the time of and soon after surgery. Sometimes pulmonary embolism causes sudden death, but most often patients will develop sudden shortness of breath and chest pain.  Certain conditions that exist may indicate a patient may have a higher risk of developing a pulmonary embolism including:

• BMI of 60 or higher;
• Chronic lower extremity edema;
• Obstructive sleep apnea and;
• Previous pulmonary embolism;
• Prolonged immobility;
• Family history of blood clots;
• Smoking.

In addition to identifying high-risk patients, there are other preventative measures physicians should take to minimize the risk of pulmonary embolism including administering blood thinner therapy (heparin), using compression stockings to keep blood flowing in the veins and encouraging patients to walk as soon as possible after surgery.

Talk to our Bariatric / Weight loss Surgery Attorneys

It is the responsibility of surgeons and staff to educate the patient and family on the symptoms or postoperative complications. Early recognition of these complications and meticulous attention to details are of paramount importance for bariatric surgeons. They are obligated to monitor their patients' postoperative recoveries and take their patients complaints seriously. Failure to diagnose and treat complications of bariatric surgery can result in permanent injury or death. If you or a loved one has suffered an injury or death following a bariatric or weight loss surgery, perhaps we can help. To contact our bariatric or weight loss surgery Medical Malpractice group for a free case evalutaion, please complete our free case evaluation form above.

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