By G. Wesley Clark, MD, bariatric surgeon, San Diego, CA
(co. 2003, reprinted by permission of the author)
I am a weight-loss surgeon, with an experience of over 2000 operations, over the last 17 years. I was an originator of the Laparoscopic Gastric Bypass, Roux en-Y. My personal mortality is about 1:1000 for the laparoscopic procedure, somewhat higher for the open operation (not because the operation is more dangerous that way, but because more high-risk patients must be done by that method). I have the advantage of operating in a hospital where the entire team has experience, and where we have special equipment for the obese patient.
Mortality from surgery is usually determined by taking mortality from all causes within 30 days of the operation. For example, if one had a minor and safe operation, and was run down by a beer truck 27 days later, it would be considered a surgical mortality, even though it is apparently not related to the operation. This is a very stringent method, but eliminates any judgments about whether or not the death was caused by the operation. This method may overstate mortality from a safer operation: if one gets better fast, and is more active, there is a slightly greater chance of death from an unrelated cause, due to activity. On the other hand, a patient with severe surgical complications might survive for several months before expiring, and not be counted. That’s the problem with statistics.
Low mortality rates for 3 days after surgery are very misleading. Even the patient with a severe sepsis, or a brain-death, will usually survive for that long, and not be counted against the surgery.
The most commonly cited mortality rate for bariatric surgical operations, across the United States, is 0.5%. That looks pretty good, till you do the math and realize that means about 1 out of 200 patients will experience a fatal result.
This increased risk arises from numerous factors, and is not just for bariatric surgery, but any surgery performed on a very obese patient. I call this the “fat penalty”. The increased mortality arises from numerous factors:
One should only seek Bariatric Surgery to protect or to restore health. It is not a cosmetic operation, although it has some pleasant side-benefits. To decide whether Bariatric Surgery is right for you, the risks and the benefits should be understood, and weighed one against the other. We do that all the time in life, usually without realizing it. (I ride a motorcycle, even though I know it’s risky, because I get such a high from it. I don’t eat sushi, because I don’t like it that much, and raw fish can have bad things in it).
The benefits of bariatric surgery, beyond a lighter weight and smaller dress size, have been relatively poorly demonstrated in the surgical literature. We found (and published) that in our first 500 Laparoscopic Gastric Bypasses, there were 1572 major co-morbidities (health problems related to obesity) --over 3 per patient, on the average. Following surgery, one year later, these were reduced by 96%. Ninety-six percent of the obesity-related health problems were gone.
Of 80 diabetics, only one continued to require any medication. Risk factors for cardiac disease were dramatically reduced. Arthritic symptoms almost disappeared, and even when some joint pain remained, it was much lessened.
Dr. Kenneth McDonald has published a study of diabetics who undergo bariatric surgery, and showed a 75% reduction in mortality after surgery (even including a slightly higher than average surgical mortality).
That's the kind of results that justifies the risk of the operation -- my wife had a Laparoscopic Gastric Bypass 3 years ago, on my recommendation, and I'd be on the table next week myself, if I met the basic weight criteria, or if I developed Diabetes.
I started out years ago as a General Surgeon, taking out gallbladders, removing breasts, cutting out cancers. Nothing compares to the thrill I get when my patients return to me a year later, and want to hug me (no woman ever hugged me for taking her breast off). They've changed into beautiful butterflies, excited with their new lives, able to do things they never dared to dream about before. I became a physician, because I dreamt of healing people. I found my way to heal, and I love it.
G. Wesley Clark, MD
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