Weight loss surgery's complications devastate some patients

By Ken Carlson
kcarlson@modbee.com

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Sandi Krueger of Turlock dropped 120 pounds with weight-loss surgery, but she is hardly a success story.

The 2002 surgery led to chronic malnutrition and anemia. As the pounds melted away, so did her life.

With a sunken face and protruding collar bones, she is too weak to work and spends most afternoons on the couch wrapped in a blanket.

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Weight-loss procedures
- According to the National Institutes of Health, people considered for weight-loss surgery should have a body mass index of 40 or higher (at least 235 pounds for a person 5 feet 4 inches tall; at least 270 pounds for a person 5 feet 9 inches) and have failed to lose weight by dieting.
- Less severely overweight people are considered if they have heart problems, sleep apnea or severe diabetes.
- Bariatric surgeries help people lose weight by restricting the amount of food held in the stomach, reducing food absorption in the intestine, or both.
- Patients choosing the surgery are advised to use high-volume bariatric centers with good follow-up care.
- Equally important are the guidelines for eating, exercise and other lifestyle changes after surgery.
- Patients have clear, sugar-free liquids for seven days. The next week, they eat blended or pureed fruits, vegetables and protein four times per day, plus protein snacks, vitamins and minerals.
- Patients continue with nutrition guidelines to meet goals and maintain desired weight.
- Dramatic weight loss may improve or resolve health conditions such as diabetes, high blood pressure, high cholesterol, sleep apnea, gastric reflux.
- Surgical risks include bleeding, leaks in the staple line, bowel obstructions, hernia, spleen injury and infections.
- Long-term complications may include dumping syndrome; nausea or food intolerance; potassium, calcium or iron deficiencies; hair loss; malnutrition; osteoporosis.
On the Net: www.ucsfhealth.org/adult/medical_services/gastro/bariatric

Sources: National Institutes of Health, Bee research

She has thoughts of giving up, but wants to be there for 12-year-old daughter Megan and 19-year-old son Dustin.

"It's not acceptable leaving me like this," said the 103-pound Krueger, who at 38 looks closer to 50. "I've gone to doctor after doctor and basically they don't help me."

According to studies on bariatric surgery, patients with long-term complications are in the minority and disastrous outcomes such as Krueger's are rare. But with 200,000 weight-loss surgeries being performed each year, she and other patients believe the long-term complications deserve more attention.

Krueger's options appear to be running out. Her anemic blood hasn't been responding to iron shots and she was told last month that she can't have the gastric bypass reversed.

"This isn't a life," said Robert De Kasha, her brother. "If she doesn't find an answer, she is just going to fade away."

Spurred by a national epidemic of obesity, bariatric surgery has become a standard of care for people with weight-related health issues. It has improved the lives of people who suffered from diabetes, high blood pressure, sleep apnea and other issues, experts say. No one is sure why some bariatric patients fare better than others.

The stomach-shrinking surgery has risks, such as leaks that can cause life-threatening infections, hernias and bowel obstructions. After the surgery, patients are expected to follow nutritional and lifestyle guidelines to achieve weight loss and avoid trouble with their altered digestive tracts.

Most patients will have "dumping syndrome" at some point, when food passes too quickly from the tiny stomach pouch into the small intestine. Because the stomach hasn't broken down the food, the person gets a rush of blood sugar, rapid heartbeat, sweating and nausea.

Other patients may have iron and vitamin B-12 deficiencies years after surgery. All bariatric patients need to take vitamin supplements for life.

A nationwide study released in 2006 concluded that bariatric surgery complications are common. By examining insurance claims for 2,522 surgeries, researchers with the federal Agency for Healthcare Research and Quality found that 40 percent of patients had complications in the six months after surgery, about double the rate in previous studies.

The complications ranged from the minor to the severe, including dumping syndrome, problems with the bariatric connections, hernias, infections and pneumonia. Post-surgery problems sent 18 percent of patients back to the hospital, some for costly readmissions or corrective surgery.

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Advances decrease problems

The agency contends that surgical advances recently have lowered the complication rate to 30 percent, still high for an elective procedure, said William Encinosa, lead author of the study.

"Anytime you can cut into the intestine, you have a risk of complications," he said. "Clearly there are benefits for people who are morbidly obese, but these patients need to know what they are getting into."

Less is known about complications years after the surgery, although a 10-year Swedish study found many patients kept the weight off and had increased longevity.