hernia ? death of mom and baby post WLS

[Guest guest]

Deaths Raise Fears Over Stomach Stapling

2 hours, 1 minute ago YAHOO Top Stories

By LINDA A. JOHNSON, Associated Press Writer

An obese Massachusetts woman and her 8-month-old fetus died of

complications 18 months after stomach-stapling surgery, an apparent

first that is leading to warnings about the risks of pregancy soon

after the surgery.

The deaths raise concerns because most of the 110,000 people who have

gastric, or stomach, bypass surgery each year in this country are

women in their child-bearing years, say doctors at Brigham and

Women's Hospital in Boston who tried to save the mother and baby.

They reported on the case in a letter in Thursday's New England

Journal of Medicine (news - web sites).

Brigham surgeon Dr. E. Whang cared for the 41-year-old woman

nearly two years ago, when she was brought to their emergency

department after two days at another hospital, where the cause of

sudden pain in her upper stomach was misdiagnosed.

" She was nearly dead, " said Whang, who noted the woman had the

gastric bypass and prenatal care at other hospitals.

After tests and symptoms indicated a massive infection, Whang did

emergency surgery. He found most of the woman's small intestine had

slid through a hernia, or tear, in an adjacent membrane, a defect

sometimes left after the intestines are rearranged in the bypass

operation. The hole choked off blood to the stretch of intestines,

and the tissue turned gangrenous.

By then the fetus had died. Whang repaired the intestine, but the

woman died within a few hours. She still weighed 440 pounds; her

original weight was not available.

" This is a tragic case, but you need to look at the overall risk-

benefit of the surgery, " said Dr. Harvey Sugerman, president of the

American Society for Bariatric Surgery, an educational group for

obesity surgeons.

Sugerman said three studies show extremely obese patients have death

rates as much as four or five times lower if they undergo gastric

bypass surgery, compared with those who don't, and other research

shows lower rates of pregnancy complications after the weight-loss

surgery.

Sugerman estimated more than 110,000 gastric bypasses will be done in

the United States this year. Complications strike as many as 1 in 5

patients, and it is believed that for every 200 patients, 1 to 4 will

die.

Sugerman and other doctors said they know of no other mother-baby

deaths after the operation.

But Whang said about 85 percent gastric bypasses are performed on

women, most of childbearing age. He advised any pregnant patients

with sudden pain to see a bypass expert quickly.

" Most doctors recommend contraceptives for two years after the

surgery " to avoid pregnancy until the woman's weight stabilizes, said

Dr. Sattar Hadi, who runs the high-risk obesity clinic at Vanderbilt

University's Center for Human Nutrition.

Hadi said it's unclear whether the Massachusetts woman's hernia was

due solely to the surgery " or the fetus pushing onto the intestines. "

Dr. Mark Tucker, director of bariatric surgery at the University of

Medicine and Dentistry of New Jersey in Stratford, said such hernias

are not uncommon and can happen up to five years after the surgery.

Because fertility increases with major weight loss, he said, reports

of pregnancies within a year of surgery are becoming more common.

In the standard type of gastric bypass surgery performed on this

woman, a small pouch at the stomach's top is separated from the rest

using staples. Moving down the small intestine a few feet, the

surgeon then cuts it in two, pulls the bottom segment up and attaches

it to the new pouch. The dangling upper segment, which carries

digestive juices, is then reattached to the lower segment.

Patients then lose weight because the new pouch holds a few ounces of

food at a time, and some calories and nutrients are not absorbed

because the food bypasses much of the stomach and small intestine.

Patients must take protein and vitamin supplements to avoid

malnutrition.

Since the start of 2003, three other Massachusetts patients have died

after gastric bypass, and the state is developing guidelines to

increase safety.

The federal Medicare program has paid for stomach bypass surgeries

for a few years, but only in people with related medical conditions

such as diabetes. It covered 7,801 operations in 2003, about double

the number in 2001.

Dr. Steve Phurrough of the Centers for Medicare and Medicaid Services

said the agency recently ruled obesity can be considered an illness

on its own, so an advisory panel this fall is to recommend whether

Medicare should cover the surgery in people without related

conditions. He expects the panel will urge waiting until there's more

research on the surgery on the elderly.

" We have significant concerns about the risks, " Phurrough

said. " People die from this procedure. "

___

On the Net: http://www.nejm.org

[Guest guest]

I saw this on the news in Chicago! But it was not as detailed, Thank

you for sharing! It is sad story, but hopefully brings some

awareness of the seriousness to our situations!

> Deaths Raise Fears Over Stomach Stapling

> 2 hours, 1 minute ago YAHOO Top Stories

> By LINDA A. JOHNSON, Associated Press Writer

>

> An obese Massachusetts woman and her 8-month-old fetus died of

> complications 18 months after stomach-stapling surgery, an apparent

> first that is leading to warnings about the risks of pregancy soon

> after the surgery.

>

>

>

> The deaths raise concerns because most of the 110,000 people who

have

> gastric, or stomach, bypass surgery each year in this country are

> women in their child-bearing years, say doctors at Brigham and

> Women's Hospital in Boston who tried to save the mother and baby.

> They reported on the case in a letter in Thursday's New England

> Journal of Medicine (news - web sites).

>

>

> Brigham surgeon Dr. E. Whang cared for the 41-year-old woman

> nearly two years ago, when she was brought to their emergency

> department after two days at another hospital, where the cause of

> sudden pain in her upper stomach was misdiagnosed.

>

>

> " She was nearly dead, " said Whang, who noted the woman had the

> gastric bypass and prenatal care at other hospitals.

>

>

> After tests and symptoms indicated a massive infection, Whang did

> emergency surgery. He found most of the woman's small intestine had

> slid through a hernia, or tear, in an adjacent membrane, a defect

> sometimes left after the intestines are rearranged in the bypass

> operation. The hole choked off blood to the stretch of intestines,

> and the tissue turned gangrenous.

>

>

> By then the fetus had died. Whang repaired the intestine, but the

> woman died within a few hours. She still weighed 440 pounds; her

> original weight was not available.

>

>

> " This is a tragic case, but you need to look at the overall risk-

> benefit of the surgery, " said Dr. Harvey Sugerman, president of the

> American Society for Bariatric Surgery, an educational group for

> obesity surgeons.

>

>

> Sugerman said three studies show extremely obese patients have

death

> rates as much as four or five times lower if they undergo gastric

> bypass surgery, compared with those who don't, and other research

> shows lower rates of pregnancy complications after the weight-loss

> surgery.

>

>

> Sugerman estimated more than 110,000 gastric bypasses will be done

in

> the United States this year. Complications strike as many as 1 in 5

> patients, and it is believed that for every 200 patients, 1 to 4

will

> die.

>

>

> Sugerman and other doctors said they know of no other mother-baby

> deaths after the operation.

>

>

> But Whang said about 85 percent gastric bypasses are performed on

> women, most of childbearing age. He advised any pregnant patients

> with sudden pain to see a bypass expert quickly.

>

>

> " Most doctors recommend contraceptives for two years after the

> surgery " to avoid pregnancy until the woman's weight stabilizes,

said

> Dr. Sattar Hadi, who runs the high-risk obesity clinic at

Vanderbilt

> University's Center for Human Nutrition.

>

>

> Hadi said it's unclear whether the Massachusetts woman's hernia was

> due solely to the surgery " or the fetus pushing onto the

intestines. "

>

>

> Dr. Mark Tucker, director of bariatric surgery at the University of

> Medicine and Dentistry of New Jersey in Stratford, said such

hernias

> are not uncommon and can happen up to five years after the surgery.

> Because fertility increases with major weight loss, he said,

reports

> of pregnancies within a year of surgery are becoming more common.

>

>

> In the standard type of gastric bypass surgery performed on this

> woman, a small pouch at the stomach's top is separated from the

rest

> using staples. Moving down the small intestine a few feet, the

> surgeon then cuts it in two, pulls the bottom segment up and

attaches

> it to the new pouch. The dangling upper segment, which carries

> digestive juices, is then reattached to the lower segment.

>

>

> Patients then lose weight because the new pouch holds a few ounces

of

> food at a time, and some calories and nutrients are not absorbed

> because the food bypasses much of the stomach and small intestine.

> Patients must take protein and vitamin supplements to avoid

> malnutrition.

>

>

> Since the start of 2003, three other Massachusetts patients have

died

> after gastric bypass, and the state is developing guidelines to

> increase safety.

>

>

>

>

>

> The federal Medicare program has paid for stomach bypass surgeries

> for a few years, but only in people with related medical conditions

> such as diabetes. It covered 7,801 operations in 2003, about double

> the number in 2001.

>

> Dr. Steve Phurrough of the Centers for Medicare and Medicaid

Services

> said the agency recently ruled obesity can be considered an illness

> on its own, so an advisory panel this fall is to recommend whether

> Medicare should cover the surgery in people without related

> conditions. He expects the panel will urge waiting until there's

more

> research on the surgery on the elderly.

>

> " We have significant concerns about the risks, " Phurrough

> said. " People die from this procedure. "

>

> ___

>

> On the Net: http://www.nejm.org

[Guest guest]

> Deaths Raise Fears Over Stomach Stapling

> 2 hours, 1 minute ago YAHOO Top Stories

> By LINDA A. JOHNSON, Associated Press Writer

>

> An obese Massachusetts woman and her 8-month-old fetus died of

> complications 18 months after stomach-stapling surgery, an apparent

> first that is leading to warnings about the risks of pregancy soon

> after the surgery.

Hi everyone..

I read this article with great interest and wanted to point something

out. The holes they are talking about which causes strangulated

bowels are the holes in the mestenery when the surgery is done LAP.

There are at least 3 people that I know of from the DS boards who had

this very problem and are extremely lucky to be alive. They are

almost impossible to detect before it gets bad, so caution on the

Doc's part is very critical. I know all of the DS Doc's who perform

LAP make sure all holes are now sewn up to avoid this type of life

threatening problem.

Those of us who had open procedures do not have this particular worry

as there were no holes poked into the mestentery, but a straight cut

along the abdominal wall.

Best of luck.

Liz

[Guest guest]

That's sad. I never post at all, actually I don't think I've posted

since I found out I was pregnant and my baby is now 3 months old..

gosh, I'm awful. ;( She weighed 8 lbs 2 oz though and I got preggo

at 6 months out. I gained 20 lbs and they were all gone within a

week of delivering.

But anyway .. this sort of thing freaks me out. I had AWFUL upper

abdominal pains during pregnancy. There at the end I was up at

least once throughout the night - every night - taking tylenol and

gas X to relieve the pain. Though I never complained about it

(stupid I know) and never contacted my surgeon. I blew it off as

scar tissue or gas. I don't have any problems now and haven't since

about 3 weeks after delivery. I do get awful pains when I eat

certain foods, so I assume that maybe it was just terrible gas?! I

tend to stay away from veggies, fruits, etc because I don't want to

suffer later on. But wow, reading stories like that can really make

you wonder. ;( I'm almost scared to ever think about having another

baby. Maybe I should just be happy with the one I have and not

chance it?! The surgery is wonderful, but I'm always scared

something may go awry inside of me and eventually do some damage.

Is it paranoid to think that way?

a

350/224/???

[Guest guest]

> What is DS?

Hi there..

DS stands for Duodenal Switch. It is another type of weightloss

surgery.

:-)

Liz