Obesity treatment: Experts have warned of the risks to women who become pregnant soon after stomach-stapling surgery for extreme obesity.
According to a report in this week's New England Journal of Medicine, a 41-year-old woman and her eight-month-old foetus died of complications 18 months after she underwent the weight-loss surgery.
The woman was referred to the Brigham and Women's Hospital in Boston with upper abdominal pain. When she was operated on, surgeons found that her small intestine had slid through a hernia (a narrow opening) created by the rearrangement of the abdominal organs during the stomach-stapling surgery. The narrow hernia had cut off the blood supply to the woman's small intestine and it had turned gangrenous. Both the woman and her baby died. It is believed to be the first case of its kind recorded.
Experts here and in the US, while acknowledging the tragic nature of the case, defended the use of surgery in extremely obese patients. Dr Harvey Sugerman, president of the American Society of Bariatric Surgery, said several studies had shown that extremely obese patients had death rates five times lower after gastric bypass surgery compared with those who had no intervention. "You need to look at the overall risk-benefit of the surgery," he said.
A gastrointestinal surgeon in the Republic said the complication of internal herniation was not confined to surgery for obesity. "It could happen if someone had surgery to bypass a tumour," he said.
In standard gastric bypass (stomach-stapling) surgery, a small pouch is made at the top end of the stomach using staples.
The surgeon then cuts the small intestine in two, pulls the bottom segment upwards and attaches to the new pouch.
Because the pouch holds only a small amount of food at a time, patients feel full more quickly and they lose weight.
The effect on their health can be quite dramatic; in one case, a patient's diabetes was reversed and their insulin treatment was stopped.
An alternative form of surgery for obesity is to place an adjustable band around the stomach using a laparoscope.
The volume of the stomach is then adjusted from the outside depending on the person's weight loss. Surgery for obesity is only carried out in people with a Body Mass Index (weight in kg divided by height in metres squared) of 35 or greater. - (Additional reporting: AP)