Bariatric Surgery Complications &
10 Ways to Minimize Your Risk

Bariatric surgery complications affect about 15% of patients1. Complications range from minor to severe and could be a single event or chronic in nature. This page will help you compare and minimize your risk of complications associated with each type of weight loss surgery.

• Factors that increase your risk for complications
• 10 Ways to Minimize your risk
• Potential complications by type of bariatric surgery
  
• Patient experiences with complications (please share your own as well)
• A to Z List of Potential Complications - Complete list, definitions & treatments

Factors That Increase Your Risk of Bariatric Surgery Complications

Bariatric surgery dramatically improves or cures many obesity health problems. But some of the same problems you’re trying to improve -- as well as working with an inexperienced surgeon -- can increase your risk for complications (definitions of bariatric surgery complications can be found further down the page)...

• The higher your body mass index (BMI), the more likely you are to have bariatric surgery complications. Some surgeons will want you to begin a physician-observed bariatric diet and weight loss surgery exercise program as soon as possible to reduce your weight prior to surgery (however, many bariatric surgeons do not require that you lose weight prior to surgery).

• Obesity-related health problems prior to surgery are directly correlated with developing complications in the first 180 days following surgery.2 An additional obesity health problem prior to surgery is associated with…
• 27.5% higher likelihood of dumping syndrome
• 24.5% higher likelihood of bariatric surgery complications associated with anastomosis (a connection of the normally separate parts of your digestive system in procedures like duodenal switch and gastric bypass surgery)
• 23.5% higher likelihood of sepsis
• Sleep apnea and gastroesophageal reflux disease (GERD) are the pre-operative conditions that result in the highest risk for bariatric surgery complications.
• Diabetes, sleep apnea and arthritis can determine your risk for sepsis.
• If you have had deep vein blood clots ( blood clots in legs or arms ), a pulmonary embolism or clotting problems in the past, you have a higher risk of experiencing them following bariatric surgery.
• High blood pressure prior to surgery can increase your risk of blood clotting problems after surgery.
• Working with a less experienced surgeon increases your risk of serious complications. For example, one study of over 15,000 patients found that the more cases a surgeon worked on, the lower the rate of serious complications:³¹

Talk to your surgeon about how your specific health issues could impact your risk for bariatric surgery complications. More specifically, find out if they can obtain access to one or more of the following (share this page with your surgeon):

• Metabolic Acuity Score (MAS) - Recently developed by researchers from Arizona, this scoring system rates your risk on a scale of 1 to 4 and, according to the researchers, “can help reduce post-surgical complications by 65% and hospital readmission rates by more than 80%.”
• Obesity Surgery Mortality Risk Score (OS-MRS) - This similar test has been devised by a weight loss surgery program director from North Carolina. It measures patients' risk of being one of the less than 0.2% who die from surgery complications within 30 days following the procedure.
• M-SCORE VTE Risk Prediction - Uses a series of risk factors to help surgeons choose the best procedure based on patient risk level and to identify risk factors that can be reduced prior to surgery.

10 Ways to Minimize Your Chances of Bariatric Surgery Complications

Whether or not you are more predisposed to bariatric surgery complications, there are 10 things that you can do to reduce your risks...

1. Pick a good surgeon and ask all the right questions. This is the most important point by far.
   1. Most surgeons offer free seminars that teach you about your options and their office's specific results. The seminars also allow you to get to know the surgeon prior to a one-on-one consultation (usually free as well).
      
      Click here to find and schedule a free in-person seminar or one-on-one consultation with a qualified weight loss surgeon in your area.
   2. You can also review our How to Choose the Right Bariatric Doctors & Bariatric Weight Loss Center page to learn how to interview and choose the best surgical team.
2. Follow your doctors' and nutritionist's/dietitian's advice to the letter.
3. Educate yourself about what to expect before, during and after surgery. Beginning this life-changing process with complete awareness is key to a successful outcome. Bariatric Surgery Source will give you the knowledge you need to be prepared. We also recommend reading a good book or two... the ones pictured to the right are all good options depending on the "angle" you prefer.

In addition, talk with a few patients of your chosen surgeon. Find out what issues they experienced and consider how their stories could apply to you.  Good bariatric surgeons will be happy to refer you to some of their patients.

4. Educate your family and close friends about the changes you will experience.  Their understanding of your new habits and the reasons you have decided to move forward with surgery will make it much easier to stay on track.
5. Lose as much weight as possible prior to surgery. The lower your body mass index (see our Body Mass Index Formula page), the lower your risks. However, weight loss prior to surgery is a challenge for some patients, and many bariatric surgeons do not require it.
6. Eat a healthy bariatric diet in the months prior to surgery.
7. If you have surgery out of your area, plan to stay close to your bariatric surgery center and surgeon for at least 10 days (preferably 2 weeks) after surgery. The two weeks immediately following surgery are the riskiest. If any bariatric surgery complications arise, you want to be close to the doctor who performed the surgery for advice and treatment.
8. Exercise as soon as possible after surgery - the quicker you can get up and moving after surgery the better. However, you don't want to overdo it, so talk with your doctor and review our Exercise for Bariatric Surgery Patients section to learn an appropriate program.
9. Use compression stockings, pneumatic compression devices (special machines that gently squeeze your legs to help keep the blood flowing) and blood thinners after surgery to reduce the risk of a blood clot.  Your surgeon should have each of these available after surgery.
10. Have and use an effective support system of family, friends, a good in-person weight loss surgery support group and a well-rounded online weight loss support group. It is nearly impossible to succeed without the support of those close to you, and your chance of long-term success increases greatly if you’re able to talk with others who understand and will listen without passing judgement.
    

Potential Bariatric Surgery Complications & Side Effects by Type of Surgery

The following chart reviews the bariatric surgery complications that could arise as a result of each weight loss surgery.  Certain complications are a risk for all surgical procedures, regardless of whether the procedure is related to weight loss. We have left these “general” risks out as well as the more rarely seen weight loss surgery complications.

This chart is meant to give you an initial understanding of potential surgery complications. You will work directly with your bariatric doctors to make a final determination of your potential risks. In addition, just because a box is not checked does not necessarily mean that your chances of having that problem are zero.

Notice that restrictive procedures that use an implanted band (lap band surgery and VBG) have similar bariatric surgery complications. But just because these two procedures have similar possible complications doesn't mean that they're the same. Gastric banding has been shown to be a much more effective procedure than VBG with lower complication rates in most cases.

Likewise, procedures that alter your digestive system (gastric bypass, duodenal switch and mini gastric bypass) are similar in regards to their types of bariatric surgery complications, but the rate of each complication may differ in frequency and severity.

Out of all the procedures, gastric banding (lap band surgery) appears to have the lowest level of and least severe bariatric surgery complications. The trade-off is less weight loss.

The gastric sleeve is in a class of its own as it is purely restrictive but uses no band. It may be a "best of all worlds" procedure with similar weight loss as gastric bypass with the lower and less severe complication rate of gastric banding. We are extremely excited about it, but more research is needed to confirm that GS works over the long-term.

See our Types of Bariatric Surgery page for a broader comparison of all procedures.

Bariatric Surgery Complications, Risks & Side Effects, Definitions and Treatments

As bariatric surgeons’ techniques, research and experience develop, bariatric surgery complications continue to decrease.

Currently, about 15% of bariatric surgery patients will experience complications according to a recent study by the Department of Health & Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ).1 

Regarding major adverse bariatric surgery complications (the development of blood clots in the deep veins of the legs or in the pulmonary artery of the lungs, repeat surgeries or failure to be discharged from the hospital within 30 days of surgery), only about 4% of patients experience one or more of them.3 However, the bariatric surgery mortality rate is extremely low at 0.135%.4

When evaluating bariatric surgery complications, it is important to keep in mind the risks that you are avoiding by having surgery. In addition to the health problems addressed by weight loss surgery, morbidly obese people who receive bariatric surgery are 89% less likely to die over any 5 year period than morbidly obese individuals who don't have surgery.5 (See our Life After Weight Loss Surgery page for more about which health problems are improved or eliminated following surgery.)

Your Experiences with Bariatric Surgery Complications

Please share the bariatric surgery complications you experienced or are concerned about. Your experiences will help other patients make decisions and avoid pitfalls.

Include anything related to bariatric surgery risks, complications or side effects, such as...

- Which procedure did you have/are you considering?

- Which problems did you experience/are you concerned about?

- Which did your doctor say you were at risk for? How did that compare to what actually happened?

- What did you do/are you doing to minimize your risk?

- How have you addressed the problems?

Other visitors' experiences with/thoughts about bariatric surgery complications

Click below to see contributions from other visitors to this page...

A to Z List of Potential Bariatric Surgery Complications

Click on a letter below to jump to a bariatric surgery complication beginning with that letter or scroll down the page to review the complete list of complications, definitions30 and treatments...

A

Abdominal hernias - a protrusion of an organ or part through connective tissue or through a wall of the cavity in which it is normally enclosed - also called a "rupture". Most hernias are treated with surgery unless another condition makes surgery inadvisable.

Abscesses - a localized collection of pus surrounded by inflamed tissue. Abscesses are drained percutaneously (through the skin) or through surgery.

Aches - see Body Aches.

Anastomotic Leaks happen when the surgical connection made during bariatric surgery leaks digestive contents into the abdomen. See Gastrointestinal Leaks for more.

Anesthesia complications - See General Anesthesia Complications.

Anemia - a condition in which the blood is deficient in red blood cells, in hemoglobin or in total volume. Anemia is a common issue stemming from vitamin deficiency after malabsorptive bariatric surgery procedures.

Anemia following bariatric surgery is routinely treated with iron orally and, when indicated, with intravenous iron infusions; blood transfusions are rarely required. Finding and treating anemia before surgery with iron and ESA therapy has been found to be effective at both avoiding transfusions and reducing surgery risks.6

B

Band Problems

• Band Erosion (also called "Band Migration") - occurs in gastric banding (lap band surgery) and vertical banded gastroplasty patients as these are the only bariatric procedures involving a band. Band erosion occurs when the band actually grows into the stomach. The only treatment is a permanent removal of the band. See our Lap Band Erosion page for more information.
• Band Intolerance - when patients do not respond well (i.e. excessive and continued vomiting) to the band placed during vertical banded gastroplasty or gastric banding (lap band) surgery. Will probably require that the band be permanently removed.
• Band leak (1.1% - 4.9% of lap band patients) - patients can usually tell if their lap band system has a leak if their feelings of restriction (how much they can eat) decrease over time without the doctor unfilling the port. To determine if you have a lap band leak, your doctor may inject colored fluid and take an X-Ray to see if any of the colored fluid is present (from a leak) outside of the lap band system. Surgery is usually required to repair it.
• Band Migration - See Band Erosion.
• Band Slippage - occurs when the lower part of the stomach "slips" up through the band, creating a bigger pouch above the band (only occurs after gastric lap band surgery and vertical banded gastroplasty as these are the only bariatric procedures involving a band). As many as 1 in 10 patients experience this with gastric banding (lap band surgery), and either removing fluid from the lap band or surgery is required to repair it. Symptoms include vomiting and reflux. It is diagnosed by drinking a dye and using X-Ray to observe it.  For information about surgical techniques to reduce the risk of slippage, see our Gastric Lap Band Procedure page.

Bleeding - See Hemorrhage.

Blood Clots (also called "thrombus") - overweight people have a higher risk of developing blood clots during and after any kind of surgery. Blood thinners are usually administered during and after surgery to avoid them, along with special devices that squeeze the lower legs to keep the blood flowing. Walking around periodically after surgery is also very effective. Symptoms of blood clots include swelling or pain in the legs and can be diagnosed by your doctor with an ultrasound. If clots occur, they are treated by a taking a prescribed blood thinner. If left untreated, clots can lead to a pulmonary embolism. Prior to surgery, be sure to tell your doctor whether you or anyone in your family has a history of clotting. Smoking will increase your risk, so if you are a smoker it is recommended that you stop smoking as soon as possible before surgery - no later than two months out. For more information, see our Blood Clot Symptoms, Treatments & Prevention page.

Body Aches - should pass with time.  If they become unbearable, talk with your doctor about which pain relievers are safe.  You should typically avoid NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen or Aleve.

Body Feeling Changes

• Feeling cold - this is caused by both your changed metabolism and weight loss and the fact that you have less fat insulating your body.
• Weak or tired feeling - should pass with time, especially once your new bariatric diet is in place and, as soon as you are feeling up to it, your weight loss surgery exercise program has begun.

Bowel Function Changes (especially more frequent bowel movements and/or foul-smelling flatulence) - bowel function after bariatric surgery may change in a number of ways,7 including... 

• Diarrhea or loose stools (especially after gastric sleeve surgery, duodenal switch, gastric bypass surgery and mini gastric bypass surgery) - usually completely dependent on diet - you will need to figure out and avoid foods that "trigger" diarrhea. Could also be the result of lactose intolerance which would require dairy products to be removed from your bariatric diet.

AFFILIATE

• Constipation (especially after gastric banding (lap band surgery), gastric bypass, mini gastric bypass and rarely after duodenal switch) - usually fixed by increasing the amount of water you are drinking and taking fiber supplements such as Fiber-Stat's liquid fiber supplement (aff).
• Foul-smelling bowel movements & flatulence (especially after duodenal switch) - as with diarrhea, it is usually dependent upon diet.
• Difficulty swallowing ("dysphagia") (after all restrictive procedures) - caused by eating too quickly, too much or not chewing food enough and can usually be fixed by avoiding these issues.  (See our Bariatric Eating page to learn about proper eating techniques that will avoid problems.)
• Gurgling Noises - not necessarily uncomfortable or dangerous, but it's worth noting.  Gurgling noises are completely normal and are due to air in the stomach and the different way that your new digestive system pushes the air through.  The best way to avoid gurgling noises is to avoid swallowing air (i.e. avoid carbonated beverages, sipping through a straw, eating or drinking too quickly and chewing gum).

Bowel Obstruction - also called an "internal hernia", is a lifelong risk following bariatric surgery that occurs when the intestines twist and prevent the flow of food and digestive fluids. Patients with this condition usually experience abdominal pain, abdominal swelling or vomiting. A doctor will confirm the diagnosis with a CAT scan or through surgery, and surgery may or may not be needed to treat it.

Bowel obstructions post-surgery are more commonly associated with adhesions and not internal hernias, although both are known to be associated with post-op bowel obstructions.

Bowel Perforation - See Organ Injury During Surgery.

C

Cold feeling - See Body Feeling Changes.

D

Death - the bariatric surgery mortality rate is extremely low at about 0.135% and has continued to drop over time.5  For a boiled down list of issues that directly contribute to mortality risk, see our Bariatric Surgery Risks page.

Deep vein thrombosis (DVT) is a risk after any surgery (bariatric or otherwise) marked by the formation of a thrombus within a deep vein (as of the leg or pelvis) that may be asymptomatic or accompanied by symptoms (such as swelling and pain). DVT is potentially life-threatening if dislodgement of the thrombus results in pulmonary embolism . Preventive measures are extremely important, especially for those with a history of blood clotting problems. Blood thinners and compression stockings help to reduce the risks. Also see Blood Clots.

Dehydration - an abnormal depletion of body fluids. You will need to drink a significant amount of water in the months following surgery - as much as 2 liters per day. Not doing so can lead to nausea and vomiting which can cause even worse dehydration and other problems. In severe cases of dehydration patients must return to the hospital for IV fluids and vitamins.

Dyspepsia (also called indigestion) - inability to digest or difficulty in digesting food; incomplete or imperfect digestion of food; a case or attack of indigestion marked especially by a burning sensation or discomfort in the upper abdomen. Treatment is usually as simple as changing your diet, such as avoiding greasy foods or only drinking liquids for a certain period of time. Alcohol, aspirin and other drugs are also causes. If diet changes don't work, antacids and H2 blockers are sometimes prescribed.

Dysphagia (difficulty swallowing) - See Bowel Function Changes.

Dumping syndrome - we have an entire page dedicated to this topic, but in general it's a condition characterized by weakness, dizziness, flushing and warmth, nausea and palpitation immediately or shortly after eating. It is produced by abnormally rapid emptying of the stomach especially in individuals who have had part of the stomach removed. See our Dumping Syndrome page for more.

E

Embolism - See Pulmonary Embolism.

Esophagitis - occurring in less than 1% of patients, esophagitis is the inflammation of the esophagus. It is usually treated non-surgically by making the patient comfortable through a change in diet (avoiding fats and chocolate) and/or avoiding/prescribing certain drugs.

Esophageal dilation - is the enlarging of the esophagus (the opening, not necessarily inflammation) and is usually the result of a restrictive procedure. Most cases can be handled through deflation of the band under radiological control.8 GERD symptoms and vomiting are more frequent in patients who develop esophageal dilation.9

Evisceration & Incisional hernia - occur when an internal organ or body part protrudes through a surgical incision. More likely to occur with open procedures than with laparoscopic procedures and usually occurs months after surgery. These are typically repaired with surgery.

F

Fistulas - see Gastric Fistula.

Food trapping - when food gets caught in one of the small openings in your digestive system. Seen in 1 to 2% of lap band patients and treated by deflating the band entirely until the food passes through.10,11

G

Gallstones - small stones of cholesterol formed in the gall bladder or bile passages. Gallstones can be created following rapid weight loss which leads to their development in as many as 1/3 of bariatric surgery patients. As a result, your surgeon may remove your gallbladder during surgery or prescribe bile salt supplements after surgery.

Gastric fistula - occurring in up to 4% of bariatric surgery patients, a gastric fistula is an abnormal passage that leads from an abscess or hollow organ or part to the body surface or from one hollow organ or part to another.12 Sepsis can follow, and surgery is usually required to fix it.

Gastric fistulas are associated with the stomach (i.e. 'gastric'). However, not all fistulas are associated with the stomach, and other types can occur (such as from an intestine to intestine anastomosis.)

Related risk/complication of gastric fistula: Wound Sepsis

Gastritis - inflammation, especially of the mucous membrane of the stomach. Symptoms include bloating, excessive belching, a burning sensation in the stomach, loss of appetite, nausea and vomiting. Eating better may get rid of the problem, or your doctor may prescribe antacids or other over the counter medications.

Gastroesophageal reflux disease (GERD) - a highly variable chronic condition that is characterized by periodic episodes of gastroesophageal reflux and usually accompanied by heartburn. It may result in histopathologic changes (change in the microscopic structure) in the esophagus. It also often leads to esophagitis. GERD increases the risk of some bariatric surgery complications such as dumping syndrome and sepsis, but the condition is also improved for many following bariatric surgery.2,13  Several at-home treatments are effective, including avoiding certain foods and drinks (alcohol, citrus juice, tomato-based food and chocolate), waiting 3 hours before lying down after a meal, eating smaller meals and elevating your head 8 inches when you lay down. If these don't work, your doctor may recommend/prescribe antacids, H2 blockers or even Proton Pump Inhibitors (PPI). See our Gastroesophageal Reflux Disease Symptoms and Treatments page (coming soon) for more details.

Gastrointestinal leaks (including staple line leaks) occur when sealed or sutured (stitched) openings leak digestive contents into the abdomen. This can cause infection and abscess. Gastrointestinal leaks occur in as many as 5% of patients and can be repaired as long as it is caught early. Symptoms include fever, severe pain and a high heart rate. In order to prevent leaks, your surgeon should check the surgical connections a number of different ways, including (1) blowing air into the connection and observing whether any gets through and (2) using a dye to check for a leak. Leaks not discovered right away are usually treated by resting the stomach (being fed through an IV), but sometimes surgery is required to fix them.

General anesthesia complications - anesthesia risks increase with age and body mass index (BMI). Other health issues can also increase your risk, including circulatory or respiratory problems. However, anesthesia complications are usually minor and are relatively easy for your doctors to handle.

H

Hair loss - this can be an alarming side effect of rapid weight loss, but it is only temporary.  It happens in about half of all patients in the year following surgery.  Proper nutrition is the best defense, including protein and the right bariatric vitamins.  Several other treatments can also help, including the application of special shampoos and oils (i.e. Nioxin shampoo, flax seed oil, biotin tablets or powder).

Heart attack (also called myocardial infarction) - an acute episode of heart disease marked by the death or damage of heart muscle due to insufficient blood supply, usually as a result of a coronary thrombosis or a coronary occlusion.  Heart attacks are especially characterized by chest pain. The chances of having a heart attack during surgery are less than 0.5%.14

Hemorrhage (bleeding) - a copious discharge of blood from the blood vessels. One study showed that out of 1,700 laparoscopic bariatric surgery patients only 3 had hemorrhagic complications, none of which needed to be converted to open operations or needed reoperations.15 However, other studies have shown internal bleeding to be as high as 4% following Roux-en-Y gastric bypass surgery. After the surgeon determines the type and severity of internal bleeding, it can be resolved in a number of ways: on its own, replenishing bodily fluids, stopping the use of all anticoagulation drugs and (rarely) by transfusion or reoperation.16

Hernia - See Evisceration.

Hiatal Hernia - a hernia in which an anatomical part (such as the stomach) protrudes through the esophageal hiatus of the diaphragm. Hiatal hernias can occur after restrictive procedures when food causes the smaller stomach to bulge and push through the diaphragm. It is also not uncommon for an obese patient to already have a hiatal hernia before surgery. While it can be a "contraindication" for surgery (reason that you may not be able to have the surgery), hiatal hernias can also be repaired during bariatric surgery.17 

Hypoglycemia - Low blood sugar related to excessive insulin production. As a bariatric surgery complication, hypoglycemia is often the result of excessive dumping following Roux-en-Y gastric bypass surgery.18,19 Medications can usually help mild to moderate conditions, however surgical removal of part or all of the pancreas (which produces insulin) may be required for more serious cases. Symptoms following surgery include rapid heart rate, shaking, sweating, confusion, feeling lightheaded, bad headaches or feeling overly hungry.

I 

Incision(al) hernia - See Evisceration.

Indigestion - See Dyspepsia.

Infection - to contaminate with a disease-producing substance or agent (such as bacteria). Much more common in open surgeries than in laparoscopic surgeries due to the size of the external incisions. Usually treated with antibiotics.

Intolerance to certain foods - With a changed stomach size or digestive system, there will be certain foods that you'll need to avoid and certain diet habits you'll need to maintain. See our Bariatric Diet section for more. Also see Bowel Function Changes.

J

(none)

K

Kidney stones - stones in the kidney related to decreased urine volume or increased excretion of stone-forming components such as calcium, oxalate, urate, cystine, xanthine and phosphate. The stones form in the urine collecting area (the pelvis) of the kidney and may range in size from tiny to staghorn stones the size of the renal pelvis itself.20 Although additional research is needed, one study suggested that the risk of developing kidney stones increases after bariatric surgery due to changes in digestion and the resulting changes in the chemical makeup of patients' urine. Click here to learn more.

L

Leaks - See Gastrointestinal Leak.

M

Malnutrition/Malabsorption - See Vitamin Deficiency.

Marginal Ulcers - Marginal ulcers are relatively common after Roux-en-Y gastric bypass, mini gastric bypass, and duodenal switch (Scopinaro procedure), and are the most common in the newly created stomach pouch after Roux-en-Y gastric bypass surgery.

Ulcers can usually be avoided by an appropriate bariatric diet, by not smoking and by staying away from NSAIDs (non-steroidal anti inflammatory drugs, including ibuprofen, Aleve, etc.). You can often tell if you have one because of a burning pain in the stomach. Your doctor can confirm ulcers with an endoscopy (a scope than is inserted through your mouth and down your esophagus) and usually treat them with antacids.

N

Nausea and vomiting are one of the most common side effects of bariatric surgery and are experienced in up to 70% of patients. In one study, patients reported feeling nauseous 1.4 times per week on average after gastric banding (lap band surgery) and 2.6 times per week after gastric bypass surgery.21 They also reported vomiting 0.9 times per week on average with the band and 0.2 times per week after gastric bypass. Following the doctor's orders regarding your bariatric diet will typically fix or improve the problem. While in the hospital, receiving a larger amount of IV fluids at a faster rate may make you less likely to feel nauseous or vomit.22

O

Organ injury during surgery - Caused by surgeon error during surgery. Injuries to your internal organs during surgery are a possibility, especially the bowel, stomach, spleen or esophagus due to their close proximity to the stomach/intestines.

P

Peritonitis - inflammation of the peritoneum (the smooth transparent serous membrane that lines the cavity of the abdomen, is folded inward over the abdominal and pelvic viscera, and consists of an outer layer closely adherent to the walls of the abdomen and an inner layer that folds to invest the viscera). Peritonitis after bariatric surgery is a serious complication that is usually caused by a gastrointestinal leak. Surgery is required to fix it.23

Pneumonia - a disease of the lungs that is characterized especially by inflammation and consolidation of lung tissue followed by resolution. It is accompanied by fever, chills, cough, and difficulty breathing, and is caused chiefly by infection. Obese patients are more likely to develop pneumonia post-surgery, so it is important that patients begin deep breathing and coughing exercises following surgery to prevent it. These exercises are much easier after laparoscopic surgery than after open surgery. Should pneumonia develop, it can be treated with antibiotics.

Port problems occur in 20.5% or 1 in 5 gastric banding (lap band) patients.24 Port problems include...

• Port flip/inversion or dislodgement (10.3% of patients) - occurs when the lap band port (where fluids are taken out or added to the band) "flips over". This is typically not a serious problem and a quick surgical procedure can turn it back over.
• Port Leak (1.1% - 4.9% of patients) - as with a band leak, patients can usually tell if their lap band system has a leak if their feelings of restriction decreases (i.e. the amount they can eat increases) over time without the doctor unfilling the port. To determine if you have a port leak, your doctor may inject colored fluid and take an X-Ray to see if any of the colored fluid is present (from a leak) outside of the lap band system. Surgery is usually required to repair it.
• Port or band infection (1.5% - 5.3% of patients) - if port or band infection occurs, it is usually healed with antibiotics, but removal of the band or port may be necessary.
• Port dislocation (6.9% of patients) - similar to a port flip, a port dislocation means that your port has moved from its original location. It can be fixed with a simple operation under local anesthesia.

Postoperative bleeding - refers to internal bleeding following bariatric surgery. See Hemmorhage.

Pouch dilation - refers to the enlarging of the pouch created after certain types of surgery. For lap band surgery patients, it may be fixed by removing fluid from the band. For all procedures with a pouch, surgery is sometimes required to tighten it.25

Pulmonary embolism - embolism (the sudden obstruction of a blood vessel by an abnormal particle, such as a bubble, circulating in the blood) of a pulmonary artery or one of its branches that is produced by foreign matter (most often a blood clot originating in a vein of the leg or pelvis) that is marked by labored breathing, chest pain, fainting, rapid heart rate, cyanosis, shock, and sometimes death. Also see Blood Clots and Deep Vein Thrombosis.

Q

(none)

R

Respiratory failure is a rare but serious complication.26 It occurs when oxygen and carbon dioxide levels fall too far outside of their normal ranges. Hospital treatment includes drugs and ventilation, among other techniques.

S

Sepsis - See Wound Sepsis.

Skin Changes such as acne or dry skin occur with some patients.  The right bariatric diet and bariatric vitamins are your best defense.  There are also many over the counter creams and lotions that can help.  Worst case, partner with your dermatologist to find a treatment that works.

Spleen damage - See Organ Injury During Surgery.

Staple line leak - See Gastrointestinal Leak.

Stoma obstruction - a partial or complete blockage of the new or altered digestive opening created during bariatric surgery. See Food Trapping.

Stenosis/Stricture - a narrowing or constriction of the diameter of a bodily passage or orifice. This is most common in procedures that rearrange your digestive system such as gastric bypass surgery (up to 8% of patients) and duodenal switch surgery and results from a build-up of scar tissue between your intestine and your reduced stomach or at an intestine-to-intestine connection (anastomosis).

The primary symptom is almost always vomiting, and it is usually treated by inserting and inflating a balloon to stretch the connection between the stomach and intestine. GERD and older age increase the risk of strictures.27

Stroke - sudden diminution or loss of consciousness, sensation and voluntary motion caused by rupture or obstruction (as by a blood clot) of a blood vessel of the brain. Obese patients have a higher general risk of stroke, and bariatric surgery has been shown to reduce the risk.28

T

Thrombus - See Blood Clots.

Thrombophlebitis - inflammation of a vein with formation of a thrombus (a clot of blood formed within a blood vessel and remaining attached to its place of origin). The body's response could be to produce more clots which increase the risk of Deep Vein Thrombosis and Pulmonary Embolism. Also see Blood Clots.

Tired feeling - See Body Feeling Changes.

Thrush (yeast infection) - this can be a side effect of the antibiotics you are on to prevent infection immediately following surgery.  Symptoms include changes to your tongue such as a white coating, redness or inflammation.  This is easily cured with medicine, so let your doctor know if this starts to develop.

U

Ulcers - See Marginal Ulcers.

V

Vitamin and mineral deficiency / malnutrition / malabsorption - symptoms include fatigue, anemia and osteoporosis and are usually completely avoided by strictly following your doctor's prescribed vitamin and supplement regimen. You should also have blood work at least semi-annually to make sure that you continue to receive the proper amounts. (see our Bariatric Vitamins page for the problems associated with vitamin deficiency)

Vomiting - See Nausea and Vomiting.

W X Y Z

Weak feeling - See Body Feeling Changes.

Weight regain - Most bariatric surgery patients will experience some weight regain after the lowest weight level is reached. See our Weight Gain after Bariatric Surgery page for more.

Wound infection - See Infection.

Wound reopening refers to the opening of the external incisions made during bariatric surgery. It is much more likely to occur following an open procedure than with a laparoscopic procedure.

Wound sepsis (and sepsis in general)- a systemic response typically to a serious localized infection (as of the abdomen or lungs) especially of bacterial origin that is usually marked by abnormal body temperature and white blood cell count, tachycardia and tachypnea; specifically: a systemic inflammatory response syndrome induced by a documented infection.

While wound sepsis can occur from any source of infection, this serious complication often results from a gastric fistula. Due to the risk of wound sepsis following a gastric fistula, the fistula must be treated immediately and effectively in order to avoid sepsis.29  If sepsis does develop, patients are often treated in the intensive care unit with IV fluids and antibiotics.

Yeast infection - See Thrush.

References for Bariatric Surgery Complications Page

1. Complications and Costs for Obesity Surgery Declining. Press Release, April 29, 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/press/pr2009/barsurgpr.htm
2. Cawley J, et al. Predicting Complications after Bariatric Surgery using Obesity-Related Co-morbidities. Obesity Surgery Volume 17, Number 11 / November, 2007 pgs 1451-1456.
3. National Institutes of Health Press Release: NIH Study Finds Low Short-term Risks After Bariatric Surgery for Extreme Obesity. July 2009. Available at: http://www.nih.gov/news/health/jul2009/niddk-30.htm.
4. Duke Medicine News and Communications. Large-Scale Analysis Finds Bariatric Surgery Relatively Safe.  June 2009. DukeHealth.org.  Available at: http://www.dukehealth.org/HealthLibrary/News/large_scale_analysis_finds_bariatric_
   surgery_relatively_safe.  Accessed: September 20, 2009.
5. Christou NV, et al.   Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004 Sep;240(3):416-23; discussion 423-4. 
6. National Anemia Action Council. Anemia Management for Surgery and Bariatric Surgery Patients. NAAC Review Published: April 2, 2008. Available at: http://www.anemia.org/professionals/reviews/content.php?contentid=
   199&sectionid=14&topic.  Accessed: September 20, 2009.
7. American Society of Metabolic and Bariatric Surgery. Bariatric Surgery: Postoperative Concerns. ASBS Public/Professional Education Committee - May 23, 2007 Revised February 7, 2008. Available at: http://www.asbs.org/html/pdf/asbs_bspc.pdf. Accessed: September 20, 2009.
8. Dargent J. Esophageal Dilatation after Laparoscopic Adjustable Gastric Banding: Definition and Strategy.  Obesity Surgery Volume 15, Number 6 / June, 2005 pgs 843-48.
9. Milone L, et al. Esophageal dilation after laparoscopic adjustable gastric banding. Volume 22, Number 6 / June, 2008 pgs 1482-6.
10. Mortele KJ, et al. The Swedish Laparoscopic Adjustable Gastric Banding for Morbid Obesity. Am Journ Roentgenology 2001; 177:77-84.
11. Nocca D, et al. Laparoscopic vertical banded gastroplasty : A multicenter prospective study of 200 procedures. Surg Endoscopy 2007, vol. 21, no6, pp. 870-874.
12. Papavramidis, et al. Endoscopic management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealant. Gastrointestinal Endoscopy. Volume 59, Issue 2, February 2004, Pages 296-300.
13. Friedenberg FK, Xanthopoulos M, Foster GD, Richter JE. The association between gastroesophageal reflux disease and obesity. Am J Gastroenterol. 2008 Aug;103(8):2111-22.
14. What Dr. Luke has to Say About Evaluation Before Surgery. Available at: http://www.doctorluke.org/Transcripts/medical_eng/1_43_pre_surgery_eval.htm. Accessed: September 20, 2009.
15. Mourelo R, et al. Hemorrhagic and Thromboembolic Complications after Bariatric Surgery in Patients Receiving Chronic Anticoagulation Therapy. Volume 18, Number 2 / February, 2008 pgs 167-70.
16. Candice Jensen, MD; Amir Mehran, MD; and Catherine Lewis, MD.  Acute Bleeding After Gastric Bypass. June 2008. Bariatric Times. Available at: http://bariatrictimes.com/2008/06/11/acute-bleeding-after-gastric-bypass/. Accessed: Sept 21, 2009.
17. Salvador-Sanchis JL. Treatment of Morbid Obesity and Hiatal Paraesophageal Hernia by Laparoscopic Roux-en-Y Gastric Bypass. Obesity Surgery. Published Online Sept 2008. Available at: http://www.springerlink.com/content/56444720p41x721k/. Accessed: September 22, 2009.
18. Moreira RO, Moreira RB, Machado NA, Gon�alves TB, Coutinho WF. Post-prandial hypoglycemia after bariatric surgery: pharmacological treatment with verapamil and acarbose. Obes Surg. 2008 Dec;18(12):1618-21. Epub 2008 Jun 20.
19. Moreira RO, et al. Post-prandial Hypoglycemia after Bariatric Surgery: Pharmacological Treatment with Verapamil and Acarbose . Obesity Surgery Volume 18, Number 12 / December, 2008 pgs 1618-21.
20. MedicineNet.com. Definition of a Kidney Stone.  Available at: http://www.medterms.com/script/main/art.asp?articlekey=6650. Accessed: September 19, 2009.
21. Niccole Siegel, MS, RD, Barrie Wolfe, MS, RD, Giovanni Dugay, NP, Christine J. Ren, MD.  REPORTED INCIDENCE OF VARIOUS POST OPERATIVE EXPERIENCES ASSOCIATED WITH THE LRYGB, LAGB AND LBPD/DS.  New York University Program for Surgical Weight Loss, New York, NY, USA.  June 2004. Abstracts of the 21st Annual Meeting - American Society for Bariatric Surgery. 
22. Schuster R, et al. Intra-operative Fluid Volume Influences Postoperative Nausea and Vomiting after Laparoscopic Gastric Bypass Surgery. Journal Obesity Surgery Volume 16, Number 7 / July, 2006 Pages 848-851.
23. Ettinger, et al.  Closure of the Abdominal Cavity after Severe Peritonitis in Bariatric Surgery Utilizing a Mesh and Plastic Device.  Journal Obesity Surgery. Volume 15, Number 9 / October, 2005 Pages 1336-1340.
24. Preventing port site inversion in laparoscopic adjustable gastric banding. James R. Piorkowski, Scott J. Ellner, Arun A. Mavanur, Carlos A. Barba. Surgery for Obesity and Related Diseases - March 2007 (Vol. 3, Issue 2, Pages 159-161, DOI: 10.1016/j.soard.2007.02.009)
25. Foletto M, et al.  Laparoscopic Gastric Rebanding for Slippage with Pouch Dilation: Results on 29 Consecutive Patients. Journal Obesity Surgery. Volume 18, Number 9 / September, 2008 Pages 1099-1103.
26. Morino M, et al. Mortality After Bariatric Surgery: Analysis of 13,871 Morbidly Obese Patients From a National Registry. Annals of Surgery: December 2007 - Volume 246 - Issue 6 - pp 1002-1009.
27. Blackstone RP, Rivera LA. Predicting Stricture in Morbidly Obese Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass: A Logistic Regression Analysis. Journal of Gastrointestinal Surgery. Volume 11, Number 4 / April, 2007 Pages 403-409.
28. Obesity Blamed for Rising Stroke Rate in Women. ConsumerAffairs.com. Feb 2008. Available at: http://www.consumeraffairs.com/news04/2008/02/obesity_stroke.html. Accessed: Sept 21, 2009. 
29. Endoscopic management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealant. Spiros T Papavramidis, Efthymios E Eleftheriadis, Theodossis S Papavramidis, Katerina E Kotzampassi, Orestis G Gamvros. Gastrointestinal Endoscopy - February 2004 (Vol. 59, Issue 2, Pages 296-300) 
30. Definitions are from MedlinePlus, a service of the U.S. National Library of Medicine and the National Institutes of Health. Online medical dictionary available at: http://www.nlm.nih.gov/medlineplus/mplusdictionary.html
31. Birkmeyer NJ, et al. Hospital complication rates with bariatric surgery in Michigan. JAMA. 2010 Jul 28;304(4):435-42.

[Last editorial review/modification of this page: 11/8/2011]