This is a guest article written by Silvio Aladjem MD

(This is a follow up of blog “First Do No Harm”) published January 23, 2017)

In the history of medicine, each century had at least one type of treatment which became fashionable and as such embraced by the public at large without thinking much about it. Since the ancient Greeks (BC) bleeding the patients (Bloodletting) to get rid of the bad “humors”, which were thought to be the cause of disease, has killed thousands and thousands of patients because they were left without enough blood to survive. According to historical records, our first president, George Washington, was bled an estimated 4 to 5 pints of blood because of a sore throat. He died a few days later. As late as the 19th century, this procedure was still being used by physicians to “rebalance the humors”.

During the 20th century it was brain lobotomy for certain mental problems. President Kennedy’s sister was subjected to it, and as a result she had to be institutionalized for the rest of her life. Many other patients were incapacitated for life by this procedure.

We are now in the 21st century and the fashionable procedure of our time seems to be Bariatric Surgery. This surgery has been devised for extremely obese patients to allow them to lose weight and return to a normal life, in the hope to avoid heart conditions, diabetes and a score of other diseases related to extreme obesity.

The idea of bariatric surgery is to limit the food intake, which is achieved by way of several methods: 1) adjustable gastric band which limits the amount of food that one can ingest; 2) sleeve gastrectomy (removal of part of the stomach, reducing its capacity); 3) gastric by-pass (Roux en Y procedure) which creates a smaller stomach pouch (about 1 oz. in capacity) and re-routes the small intestine to the newly created stomach pouch bypassing the duodenum and 4) biliopancreatic diversion with duodenal switch. Because of problems with food absorption this procedure is rarely performed.

Except for the gastric band procedure which can be reversed by removing the band, the others are permanent and can’t be reversed because surgery changed forever the anatomical normal connections and relations.

Bariatric surgery is not a benign surgery. Actually, someone I respect told me that it amounts to anatomical and physiological mutilation. As such it can have dire health consequences including death.

Bariatric surgery is widely promoted. The number of bariatric surgeries has skyrocketed throughout the nation and the latest figures show that close to 200,000 patients a year undergo bariatric surgery. What was devised for extreme obesity, also known as morbid obesity, now is being performed on dubious indications upon patient request. Hospitals are promoting it because these are very profitable procedures and surgeons are not far behind. Workshops for patient information are appearing in malls. Every hospital where bariatric surgery is performed has special patient education programs which is really a recruiting effort. Some physicians counsel their patients to have it because it will protect them from developing Type 2 diabetes and obesity.

Risks are disclosed, but minimized, and of course patients are inclined to believe that complications occur to other people not to them.

According to Mayo Clinic (www.mayoclinic.org) short term complications are similar to any abdominal surgery and can include: excessive bleeding, infection, adverse reactions to anesthesia, blood clots, lung or breathing problems, leaks in your gastrointestinal system.

Long term risks and complications of gastric bypass can include: bowel obstruction, dumping syndrome causing diarrhea, nausea and/or vomiting, gallstones, hernias, low blood sugar (hypoglycemia), malnutrition, stomach perforation, ulcers, vomiting.

Most recently, a bone metabolic disease resulting in multiple spontaneous fractures, has been reported several decades after bariatric surgery. (https://bit.ly/2G4uQk0).
There are other potential problems that have not yet come to light. The problem is that once the patient leaves the hospital most likely will be lost to follow up and may never appear in statistics. I personally know of two such cases. One, a lady who five years after her surgery developed a lung complication which was attributed to bariatric surgery and which ultimately took her life. The other one, who is 30 years after surgery, has abdominal fistulas which, in spite of treatment, never closed.

While postsurgical deaths are rare after any surgery, we do not have accurate data to estimate it for bariatric surgery. I personally know of six such deaths post bariatric surgery although, for the purpose of full disclosure, I did not have access to their medical records to unequivocally confirm the cause of death for these patients.

All in all, bariatric surgery is not a short cut to avoid the gym and life style changes. If you are not morbidly obese, go to the gym, diet, and forget fast foods. You will be better off.

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SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. Should you wish to contact him, you may do so at: dr.aladjem@gmail.com

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