Obesity Surgery Perth
What if there are complications?
Complications of bariatric surgery
All surgery has complications; there’s no avoiding it. However, our attitude is to do everything we can to keep them to a minimum. In the unlikely event they do occur, our specialist bariatric surgeons will deal with them promptly, before they get out of control.
The vast majority of the clients at our Perth clinic go through the process without any problems, but complications can happen. As much as we don’t like it, they need to be sorted out quickly and effectively so you can get back to your family, work and whatever is important in your life.
Complications of bariatric surgery | Perth bariatric surgeons
What is the role of the patient in the case of a complication?
It is very important that anything that doesn't feel right is reported to your bariatric surgeon immediately. All of our surgeons are happy to receive phone calls at any time. The majority of calls are false alarms and we don’t mind that at all, we would prefer just to know.
We arrange a lot of blood tests and scans to check on people, and we watch and monitor all these situations very carefully.
The only time that patients really do get into trouble and things turn nasty, is when they have been ignored and left to fester. Don’t wait. Call us at any time.
What can I do to minimise the risk of a complication?
Stop smokingThis is the single biggest risk factor. It also makes complications hard to treat and slows the recovery phase.
Follow the instructions given to you by your surgeonEspecially the preoperative diet to help your surgeon get access to your stomach, and the postoperative diet so you don’t put any pressure on the staples and blow out a hole.
Attend all your follow up appointments as they are essentialWhen you show up, we can provide you with the highest standard of surgical aftercare. This is the greatest opportunity to get all the information about what you should be doing to recover well.
So what complications can happen?
This is the most serious complication. A leak can happen from any of the staple lines or from any of the surgical joins. Leaks can happen up to 8 weeks after the initial surgery (and very, very rarely after that). The risk of getting a leak is under 2%.
How do we handle a leak?
There are lots of options. If the leak is contained then we can usually manage with just an endoscopy and internal drainage. If it’s a bit more than that, we may need to re-operate and drain all the leaking fluid. If there is a MiniMizer ring in place, we like to remove the device as this can often get infected.
You may be in hospital for up to three months, and you may need to have endoscopies to check, stretch, and reposition your sleeve for up to twelve months. The extra time in hospital means time away from work and the family. There will be extra costs incurred (not from your surgical team) but from pharmacy/blood tests/the hospital etc. Make sure you discuss these with your hospital team.
This is always possible, as the surgery involves operating near some very large blood vessels. Your surgeon will be very careful to avoid these. In addition, we use a combination of techniques to prevent bleeding. Any bleeding that does occur is usually minor, can be managed with medication, and stops by itself. Sometimes it needs a blood transfusion, and very rarely a return to the operating theatre.
If you are unable to receive a blood transfusion because of personal or religious convictions, please let us know so we can prepare for this. There are different options available for managing these situations.
The risk of a clot increases around the time of surgery, especially in smokers and people on hormone treatment or contraceptives. We like to stop all of these risk-inducing factors prior to surgery. Afterwards, we also use Clexane injections, as per the Australian Guidelines, to reduce the risk.
Clots can occur in the calves or the pelvic veins and subsequently migrate to the lungs. Alternatively, clots can also occur around the veins within the abdomen. Once controlled, a clot can be managed with Clexane injections for an extended period of time and they usually dissolve.
However large clots can be very dangerous. The critical thing is that we get onto them early before they have a chance to get bigger. Moving around and keeping the blood flowing is really important. Do try to walk around the same day as your operation, (with help), and keep yourself active.
The most important thing is that if you are not well after surgery - we need to know.
What is dumping syndrome in weight loss surgery?
This term is frequently overused. True dumping syndrome relates to what happens if sugar is allowed into the small intestine in large quantities. It happens in people who have had bypass operations, but may happen in people that have had sleeve gastrectomies as well. Dumping syndrome is said to occur in up to 50% of bypass patients.
What are the stages of dumping syndrome?
Phase 1The sugar in the small intestine has a high osmotic pressure. The small bowel lining starts to pour water into the small bowel to dilute the sugar and reduce its osmotic pressure. This means that water is moved out of the circulation into the bowel. This results in a fall in blood pressure, resulting in dizziness, palpitations, hypotension, sweating, headache, flushing and disorientation. The feeling of needing to sit down. This often happens approximately 15-30 minutes after eating a sugary meal.
Phase 2The sugar gets absorbed pushing the blood sugar very high.
Phase 3In response to the high blood sugar there is a surge in insulin release, causing the blood sugar to fall to a very low level. This will cause headaches and fainting.
Phase 4Late dumping, 2-3 hours after the meal. Unabsorbed sugar gets to the colon where bacteria ferment it, causing a gassy diarrhoea.
How can you treat dumping syndrome?
- Firstly, control diet and avoid sugary foods.
- Secondly, we can prescribe medications that can help if required.
- Finally, it may be possible to undo the surgery to reduce the dumping.
About Obesity Surgery WA: Our 6 commitments
Taking surgery seriouslyWe know that entering into an operation is a big deal and we are very serious in getting the best outcome for you. We practice what is considered to be a world class standard. Our staff regularly attend national and international conferences and bring back what is the latest research and technology.
Running on timeOur Surgeons and all of our staff try their best to run on time. Although it's not always possible, our commitment is that we do our best. Your time is valuable and we respect that.
Readily availableOur surgeons (or at least one of them) are always available in a crisis. Some of them may provide you with a direct contact, but all are available through the hospital switchboard and happy to chat any time if there is a crisis.
An obsessive attention to detailWe do our best to not miss anything. Every stitch, every staple and every clip is applied to exactly where it needs to be with the greatest care possible.
Commitment to performing the best operation possibleNot all operations are the same and there a few extras that we do to make things better. We know that our results are better with the minimiser ring so we offer it to everyone. We know that reflux can be an issue so we try to tighten every oesophageal hiatus to make reflux control as good as possibly can be.
A commitment to new technologies
- We have brought in STRETTA into Western Australia, which we believe will revolutionise reflux management. (Have a look at the Stretta page for more information).
- SJOG Murdoch has just purchased a new DaVinci robot and we believe that this will allow us to do operations with keyhole surgery that previously needed a major laparotomy incision. Lynx is on the horizon and promises to also help manage reflux, we hope to have access to this in early 2020.
Meet our team
Dr. Harsha Chandraratna
Dr Andrew Kiyingi
Bariatric & General Surgeon
MBChB, PGDipSurgAnat, FRACS
Dr. Bill Gong
General and Laparoscopic Surgeon