The laproscopic techniques we now use significantly reduce complications from bariatric surgery but patients must understand that all surgeries carry risks, including a heart attack, blood clot, organ injury or failure, hemorrhage, or infection. While it is very rare in laparoscopic procedures, patients can die during or after surgery. Here are some statistics for weight loss surgery risks:

• The adjustable gastric band has the best safety record with a mortality rate of only 0.1 percent (one in a thousand). Most of the complications occur over time and not at the time of surgery. The most common: problems with the implanted port that enables doctors to adjust the band, which occurs in four percent of cases; poor alignment of the band (called a prolapse), three percent; the band penetrating the wall of the stomach (called an erosion), two percent. 
  
  
• Gastric bypass has a mortality rate of 0.2 to 0.5 percent (two to five out of a thousand). Postoperative complications include hemorrhages, in three to four percent of cases; leaks along the staple line in the stomach or at the connection between the stomach and bowels, two-and-a-half percent; intestinal obstruction, one to two percent of the time. Long-term complications include vitamin deficiencies, protein malnutrition, intestinal obstructions, marginal ulcers , strictures of the gastric pouch to intestinal leakage, and internal hernias. 
  
  
• The biliopancreatic diversion procedures have slightly greater postoperative complications than the gastric bypass. Long term complications are similar to those of the gastric bypass, but the risks of protein malnutrition and vitamin deficiencies are greater. 
  
  
• All of the procedures also have the risk of weight loss failure or weight regain.

There has been significant progress made in the past several years in the development of safer and more effective surgical procedures for treating obesity. However, all surgeries, including bariatric surgery, have risks, although mortality is very low. Depending on the specific weight loss surgery, there are side effects, and a bariatric surgeon is the best person to explain them because they vary depending on a person’s weight, age, and medical history. These factors and others interact in determining one’s specific risks for weight loss surgery.

The National Institutes of Health (NIH) Consensus Development Conference on weight loss surgery concluded that, in persons who are motivated and strongly desire substantial weight loss and have life-threatening obesity-related conditions, the benefits of the surgery outweigh the risks. I think that what is most important for most people considering surgery is to think carefully about the benefits versus the risks and then decide whether surgery is right for them.

The major immediate risks are mechanical, but the longer-term risks are metabolic, nutritional, and emotional. Most patients worry the most about the risk of the surgery itself. But with our improved surgical techniques, skilled surgeons and more experience, the risks of the surgery itself are becoming small compared to the risks of remaining obese.

The long term nutritional effects are especially important with those surgeries that interfere with food absorption. When part of the intestine is bypassed, certain vitamins and minerals can pass through without an adequate amount being absorbed into the blood stream. These include certain B vitamins, vitamin D and minerals such as calcium and iron. It is extremely important that the patient receives a full education about the long-term effects of whichever surgery is chosen and that they understand that long-term they will have to be skilled at getting enough protein, fiber, water and vitamins and minerals in their diet through food, and possibly through supplements.

Nor should emotional risks be ignored. There is a temptation to believe that ideal weight can lead to an ideal life. Of course, this is seldom if ever true and change, even positive change, can be very disruptive. I encourage patients to discuss their surgical decision with all the people they want in their world after surgery. Spouses, parents, children, friends and other close family often are as frightened by what may happen as the patient. Spouses wonder what will happen to the marriage with a more active and possibly more attractive and confident partner.

All surgery comes with some risk. Before you decide, a careful discussion of your personal medical history with your surgeon will better estimate your “risk/benefit” ratio, which helps determine if this is a good choice for you. In fact, some people are too risky to undergo weight loss surgery; they may need to lose significant amounts of weight before surgery, or undergo other medical clearances as requested by the surgeon.

If you do have surgery, your surgeon will give you a list of possible short and long term risks, and the symptoms associated with them. It is essential to understand these symptoms, and get medical help as soon as possible if you experience any of them.

Some risks are related to the adherence to the lifestyle plan. Once you’ve had the surgery, overfilling the now-smaller stomach pouch can produce pain, and nausea and vomiting. Persistent vomiting must be medically addressed right away. A high sugar/fat load or other foods not well tolerated can produce “dumping” (severe cramping, diarrhea). It’s also important to make sure food is thoroughly chewed, so the small entry in the digestive tract allowing food to pass through (called the “stoma”) doesn’t get clogged up.

The best way to minimize potential risks is to be a well-prepared patient. While the short and long term anatomical risks are out of your control, quick recognition will lead to a fast resolution. For the lifestyle risks, they are under your control, and careful attention to your eating habits, with guidance from the nutrition team, will help to minimize them.