Owing to the obesity ‘epidemic’ afflicting the UK, Bariatric (“weight loss”) surgery is developing at a pace.
Within bariatric surgery are 3 different types of procedures that are commonly used so that the patient can sustain a program of weight loss, to achieve a lower BMI (body mass index) target.
The operations can be performed by incision into the front of the abdomen - between the bottom of the sternum and the belly button. Most procedures, nowadays, are performed laparascopically (aka keyhole surgery) around the location of the belly button.
The intention of surgery is to either limit the capacity of the stomach to hold food, or to limit the amount of food that can be absorbed; the former state can be achieved by gastric banding or by sleeve gastrectomy and the latter by gastric bypass. In reality, the gastric bypass reduces stomach capacity as well as moving food onto the rest of the bowel faster than usual, meaning less time for food to be absorbed.
The medical basis for these operations is to reduce the morbidity (and mortality) associated with being an obese patient. Examples of the life limiting conditions that may be experienced include severe sleep apnoea, cardiovascular and metabolic disorder such as the metabolic syndrome associated with the development of diabetes.
The risks of Bariatric Surgery are:
1) The procedure itself and complications arising from the procedure, e.g. leakage from a failure of sutured (sewn together) areas to stay together.
2) Undergoing general anaesthesia – i.e. all the risks due to the induction and during the delivery of a general anaesthetic.
3) Associated risks from co-morbidity that could affect the patient if they were to react to the anaesthetic, or their recovery following the procedure, e.g. delayed wound healing - as is seen in diabetes.
4) Bariatric surgical patients tend to be less mobile, take longer to mobilise and so are more at risk of deep vein thrombosis and pulmonary embolism. Owing to prolonged strain on their cardiovascular system, there may be an increased risk of cardiovascular failure, and an increased tendency to bleed.
The number of claims is increasing as the use of these procedures increase. Expectations by patients may also be a factor, in that none of the 3 procedures are guaranteed to produce fast weight loss. A complication incidence as high as 4% has been recorded in studies looking at the use and consequences of bariatric surgery.
Medico-legal aspects
* Misunderstanding/mis-interpretation/communication failure on behalf of the person taking the consent re: the possible complications that can occur (as listed above)
* Inadequate consent taking, i.e. not fully informing patients what could happen are the grounds of many complaints that can lead to a medico-legal claim.
* Poorly performed surgery giving rise to difficulties such as leakage at the side of the operation site. This can give rise to abdominal pain, a fast heart rate, shoulder tip pain (from irritation of the diaphragm), fever and chest pain.
* Poor post-operative care and poor follow-up by the surgical team ie., not picking up any problems relating to the development of the complications or even recognising them and failing to take part in the duty of care owed to patient. This includes missing those potential complications that occur in association with being overweight and not being mobile, such as bed sores and deep vein thrombosis.
If you want further information about this particular topic, or wish to discuss the possibility of bringing a claim for Clinical Negligence - or indeed any other type of injury, please contact the Dutton Gregory Clinical Negligence Team on (01202) 315005, or email k.marden@duttongregory.co.uk
NB This article does not constitute legal advice and should not be relied on as such. No responsibility for the accuracy and/or correctness of the information and commentary set out in the article, or for any consequences of relying on it, is assumed or accepted by any member of Dutton Gregory LLP.
