There are also long-term issues : Anemia,
nutritional deficiencies (iron, calcium, vitamin B12 and folate),
that request a regular follow-up (blood samples) and supplements. A
gastric ulcer can occur in 3% of the cases, but can be cured most
often by drugs. A stenosis of the anastomosis occurs in 5 to 7%
of the cases, with vomiting, and can be cured by endoscopic dilatation. There is
also a risk of late small bowel obstruction
due to adhesions or an
internal hernia: symptoms can be difficult to recognize if the obstruction is
located on the small intestinal limb (bilio-pancreatic limb) because there is no
vomiting, but isolated abdominal pain. A CT-scan should be performed.
One wonders what becomes of the remaining part of
the stomach : is
there more risk of cancer and how will it be detected, knowing that is no
more access through endoscopy? As a matter of fact, thousands of operations have
been performed worldwide and this complication has not been significantly reported,
whereas modern exams allow a safe examination of the remaining
stomach.
Weight-loss is constant and sustained . If you consider
the excess weight, that can be calculated according to an "ideal body weight"
given by the tables of the Life Insurance Companies,this excess should go down
by 60% in 12 to 18 months.
Exemple : a woman is 160 cm tall and weighs 110
kg. Her theoretical excess-weight is 55 kg. She may hope loosing 36 kg after
surgery.
Long-term
results are deemed better than the results of restrictive operations
such as Mason gastroplasty or lap-banding, the downside beeing more risks and more
complexity. Many surgeons around the world have chosen this operation whatever
the clinical condition, some prefer it when patients have special features
(swee-eaters or binge eaters, superobese), and some perform it when there is a
failure of a previous restrictive operation: this ultimate strategy makes sense
although it carries even more risks due to post-operative adhesions, and may be
called a "two-step strategy".
