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Obesity Risks Add to Complications of Gastric Bypass

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Duke Health News 919-660-1306

CHICAGO -- The same health risks that make morbidly obese
patients eligible for gastric bypass surgery also leave them
susceptible to complications during and after the procedure,
according to a five-year imaging study led by a Duke University
Medical Center radiologist.

The study followed patients at the University Hospitals of
Cleveland after Roux-en-Y gastric bypass surgery, the most
popular surgical procedure to aid weight loss in severely obese
patients. The surgery involves stapling the upper stomach to
create a small pouch that is then attached to the small
intestine, thereby reducing stomach capacity and the
intestine's ability to absorb nutrients.

Among the 335 patients that participated in the study,
radiological imaging revealed 57 complications from the
surgeries -- many of them multiple problems in the same
patients -- including suture tears and leaks, pulmonary
embolism, pneumonia and infection.

"Severely obese patients are at high risk for any type of
surgery because of other conditions related to their weight,"
said Duke radiologist Elmar Merkle, M.D., formerly of the
University Hospitals of Cleveland where the study was
conducted. "In addition, there is a wide spectrum of
procedure-specific complications following Roux-en-Y gastric
bypass."

Merkle presented the findings today (Dec. 1, 2003) at the
89th Scientific Assembly and Annual Meeting of the Radiological Society of North
America
.

The results emphasize that the procedure should be a last
resort after all other interventions, such as diet and
exercise, have been attempted, said Merkle. The findings also
highlight the importance of radiological imaging in diagnosing
surgical complications in severely obese patients following
gastric bypass, he added.

The researchers reported eight cases of leaks from the
stomach into the surrounding abdominal cavity and five
instances of staple line disruption in the stomach,
complications specific to Roux-en-Y. They also observed three
incidents of pulmonary embolism, two cases of pneumonia, and
single cases of severe infection and open abdominal wound
disruption -- all complications that are prevalent among
severely overweight patients undergoing any surgical procedure.
Within 30 days of the surgery, 17 patients were readmitted to
the hospital.

"This operation should not be considered a cosmetic
procedure," Merkle said. "People need to be aware of the
potential complications of gastric bypass surgery and treat it
as a last option after other less invasive interventions have
been tried."

In addition to its complications, the procedure also
requires patients to undergo major lifestyle changes, he said.
Following the surgery, patients must restrict their eating
habits and rely on vitamin supplements for adequate
nutrition.

According to the American Society for Bariatric Surgery,
63,000 people had gastric bypass surgery in the U.S. in 2002.
That number is expected to increase to 100,000 this year. The
National Institutes of Health guidelines state that patients
who are at least 100 pounds overweight are eligible for the
surgery. Patients who are less than 100 pounds overweight may
also be considered based on other life-threatening conditions
related to obesity, such as type 2 diabetes or cardiopulmonary
problems.

Co-authors of the study were Thomas Stellato, M.D., Cathleen
Crouse, Peter Hallowell, M.D., and Dean Akira Nakamoto, M.D.,
all of the University Hospitals of Cleveland.

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