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Risks should be clearly recognized, and explained to the patient before operation. They play a major role in his decision, because operation should never be the first choice. Besides, the surgeons owes to his patient a precise, detailed and understandable information.
>> Immediate risks (during hospitalisation)
The immediate risks related to the operation have nothing particular about it, speaking of a procedure on the upper GI tract under general anaesthesia : phlebitis and thromboembolism, internal bleeding, hematoma, abscess and peritonitis, perforation of the stomach. The incidence is low, from 2 to 5%. The risk for death is 1 out of 1000.
>> Mid and long-term risks
They are mostly related to the placement of a prosthesis. There will always be a risk for dysfunction, and eventually reoperation.
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Adjustable gastric banding: Erosion of the stomach due to the band occurs in less than 1% case, and entails the removal of the band. The risk of slippage of the stomach through the band is more frequent (5%), occurring 6 to 24 months postoperatively. It always requires a rapid deflation of the band, because of symptoms of vomiting, intolerance to solid and liquid food with pain. It can possibly demand a reoperation to remove or at least replace the band in a correct position. This is generally possible through laparoscopy.
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Vertical banded gastroplasty: The most frequent complication is the dismantling of the staple line, occuring in 10 to 50% cases. There are few symptoms except weight-regain, which is likely to happen in such cases. On the opposite, a stenosis can occur. If one takes into account the high frequency of wound hernia, a reoperation is likely to be necessary in more than 50% cases, with an additional risk.
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Bypass surgery: A rupture of the staple line can also occur, so as various complications due to the gastro-intestinal anastomosis. Anemia and vitamin deficiencies are others specific complications. |
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In the long run, weight-loss is not adequately distributed on the whole body, regardless the initial procedure. Aesthetic problems are likely to occur on the abdomen, thighs, arms and the breast. Plastic reconstructive surgery may be required one or two years after bariatric surgery (refer to special chapter). |
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