6.2.0.0 Ad­verse Ef­fects

The safe­ty of metabol­ic surgery has im­proved significant­ly over the past two decades, with con­tin­ued refine­ment of min­i­mal­ly in­va­sive ap­proach­es (la­paro­scop­ic surgery), en­hanced train­ing and cre­den­tial­ing, and in­volve­ment of mul­ti­dis­ci­plinary teams. Mor­tal­i­ty rates with metabol­ic op­er­a­tions are typ­i­cal­ly 0.1%–0.5%, sim­i­lar to chole­cys­tec­to­my or hys­terec­to­my (79-83,). Mor­bid­i­ty has also dra­mat­ically de­clined with la­paro­scop­ic ap­proach­es. Major com­pli­ca­tions rates (e.g., ve­nous throm­boem­bolism, need for op­er­a­tive rein­ter­ven­tion) are 2%–6%, with other minor com­pli­ca­tions in up to 15% (79-88,), which com­pare fa­vor­ably with rates for other com­mon­ly per­formed elec­tive op­er­a­tions (83). Em­pir­i­cal data sug­gest that proficien­cy of the op­er­at­ing sur­geon is an im­por­tant fac­tor for de­ter­min­ing mor­tal­i­ty, com­pli­ca­tions, reop­er­a­tions, and read­mis­sions (89).

Longer-‍term con­cerns in­clude dump­ing syn­drome (nau­sea, colic, and di­ar­rhea), vi­ta­min and min­er­al deficien­cies, ane­mia, os­teo­poro­sis, and, rarely (90), se­vere hy­po­glycemia. Long-‍term nu­tri­tion­al and mi­cronu­tri­ent deficien­cies and re­lat­ed com­pli­ca­tions occur with vari­able fre­quen­cy de­pend­ing on the type of pro­ce­dure and re­quire life-‍long vi­ta­min/nu­tri­tion­al sup­ple­men­ta­tion (91,92). Post­pran­di­al hy­po­glycemia is most like­ly to occur with RYGB (92,93). The exact preva­lence of symp­tomat­ic hy­po­glycemia is un­known. In one study, it af­fected 11% of 450 pa­tients who had un­der­gone RYGB or ver­ti­cal sleeve gas­trec­to­my (90). Pa­tients who un­der­go metabol­ic surgery may be at in­creased risk for sub­stance use, in­clud­ing drug and al­co­hol use and cigarette smok­ing. Ad­di­tion­al po­ten­tial risks of metabol­ic surgery that have been de­scribed in­clude wors­en­ing or new-‍onset de­pres­sion and/‍or anx­i­ety, need for ad­di­tion­al GI surgery, and sui­ci­dal ideation (94-97,).

Peo­ple with di­a­betes pre­senting for metabol­ic surgery also have in­creased rates of de­pres­sion and other major psy­chi­atric dis­or­ders (98). Can­di­dates for metabol­ic surgery with his­to­ries of al­co­hol, to­bac­co, or sub­stance abuse; significant de­pres­sion; sui­ci­dal ideation; or other men­tal health con­di­tions should there­fore first be as­sessed by a men­tal health pro­fes­sion­al with ex­pertise in obe­si­ty man­age­ment prior to con­sid­eration for surgery (99). Surgery should be post­poned in pa­tients with al­co­hol or sub­stance abuse dis­or­ders, significant de­pres­sion, sui­ci­dal ideation, or other men­tal health con­di­tions until these con­di­tions have been fully ad­dressed. In­di­vid­u­als with preop­er­a­tive psy­chopathol­o­gy should be as­sessed reg­u­lar­ly fol­low­ing metabol­ic surgery to op­ti­mize men­tal health man­age­ment and to en­sure psy­chi­atric symp­toms do not in­ter­fere with weight loss and lifestyle changes.