| The following was
typed in by a patient who changed his mind about having the DS - this was
the form given him by his WLS surgeon: RECORD OF HAVING BEEN INFORMED
OF THE FOLLOWING FACTS ABOUT OBESITY SURGERY
Obesity surgery is quite major surgery and is done for only strict reasons in
morbidly obese patients, with very few exceptions. Your surgeon reserves the
right to interpret these reasons and accept or reject patients for surgery based
upon his clinical judgment of them.
There are many operations available for morbidly obese patients including
stomach stapling (gastroplasty), putting a band around the stomach (gastric
banding), cutting certain nerves to the stomach (vagus nerves), jaw wiring,
balloon(s) in the stomach, etc. Continuing to try to lose weight by dieting and
not having surgery is also possible.
Many patients have done well with this surgery but there is no guarantee of any
benefit from this surgery. I accept all the risks, some but not all of which
are enumerated in this document. For each potential benefit, such as
improvements in diabetes, high blood pressure, or less back pain, etc. there
have been failures. Some obese patients have problems with breathing while the
sleep. The breathing problems may not always get better after losing weight.
It is hoped that the weight loss one year after surgery will be at least 1/3 or
1/2 of the patients extra weight. This happens in many patients, but some don't
lose weight, or they may gain their weight back afterwards. While obesity
surgery usually works, it only helps with weight loss and is not anything
"magic" or guaranteed. The patient must cooperate and make changes in lifestyle
with regular small meals for life, cut out snacks, drink almost non-calorie
liquids, eat slowly and make other changes in eating and drinking habits.
Almost every surgeon who performs obesity surgery has complications some time or
another. Every patient has a real risk for one or more complications. There
are no guarantees that a serious complication will not occur in any case. The
more serious or frequent complications that can occur are:
Wound infection or infection of a body cavity such as the chest or abdomen can
occur. Abscesses can form in the abdomen or chest, or sometimes the patient can
develop pneumonia. Inflammation of other organs can occur as well, including
the heart, lungs, liver, kidneys, gallbladder, urinary bladder or just about any
other organ. Patients have also been known to develop bleeding ulcers in the
early and late post-operative period.
The spleen may be injured during surgery and need to be removed. This can
seriously increase the risks of infection in the patient's body.
Organ failure such as that of the heart, kidney, liver, or lungs has occurred
after obesity surgery.
Clots in the lower limbs, pelvis, or elsewhere in the body can form and travel
to the lungs, causing difficulties with breathing or even death. These clots
can also result in temporary or permanent swelling or ulceration, especially of
the legs.
Fluids from the intestines or stomach can leak into the body cavity, other
organs or through the skin. They may continue to drain into a bag for a long
time.
Changes in taste and food preferences often occur. Many patients have
difficulty eating certain foods such as red meats, which they may have liked
before surgery. Sometimes after surgery certain cravings for some foods may
occur in some patients.
Food or liquids may not be able to pass through the pouch, lower stomach, or
intestines, which may need stretching (dilating) by instruments or endoscopes
(which have their own risks). Tubes for nourishment, fluids may have to be
placed into the stomach, intestines or veins, if the patient is not able to eat
or drink enough by mouth. Operation may be necessary to accomplish this.
Signature _________________________________ Date _________________
Vomiting or diarrhea can frequently occur after this type of surgery and may
make it a problem to eat certain types or quantities of food. This can be in
one sense a benefit of this surgery, because it prevents eating or drinking of
certain food(s) for fear of diarrhea or vomiting.
Bleeding from the stomach, hernia, breakdown of the surgical stitches, need to
re-operate for these or other reasons, complications of anesthesia, psychiatric
problems such as depression requiring psychiatric care, and admission to a
psychiatric ward, and even death are all possible as a result of surgery.
Across the United States approximately one in 200 patients dies after obesity
surgery.
Persistent vomiting, nausea, swelling of the abdomen, heartburn, etc. can occur
and make the patients think seriously of having the operation undone in certain
instances.
The stomach pouch or its outlet may get bigger or the staple lines open up, so
that, in time, the patient can eat more at a mealtime or even gain back to the
original or greater weight. Re-operation may be necessary and no patient should
have the obesity surgery performed who is not prepared to accept the need for
re-operation if it should become necessary.
Admission to an intensive care unit may be necessary to observe the patient
closely or to treat any of the problems that can arise from surgery.
Over the months and years, any type of nutrition problem or infection may occur,
including lack of vitamin(s), protein, calories, minerals etc. Signs of this
can include but are not limited to weakness, paralysis, confusion, rashes,
anemia, hair loss, bone and joint problems, wounds that heal poorly, tongue
soreness, night blindness and numbness, etc. After obesity surgery, taking
extra vitamins and minerals and being followed by the obesity surgeon, or a
physician well experienced in this area, is necessary for life. The patient may
need to have vitamin injections every month or so for life. It is solely my
responsibility as the patient, and not the responsibility of the surgeon or any
agent of the surgeon to arrange and adhere to the follow-up.
The patient's weight loss goal, no weight loss or even further gain of weight
may occur any time after surgery.
With weight loss, the skin on the arms, legs, neck, abdomen, face and elsewhere
may become wrinkled, sag, droop, or hang in large folds. It may become quite
annoying, embarrassing, or develop rashes or infection and odors. The breasts
are very likely to undergo a significant reduction in size and become very
pendulous or droopy. As a result, the patient may feel a need for further
surgery. If this happens, the surgeon will be available to discuss this and any
other matter. The surgeon makes no positive cosmetic claims about the surgery,
which is not performed for any cosmetic purpose.
As soon as any problem arises, medical help must be obtained soon. The patient
has the duty to call for help quickly and without delay.
All of the currently performed types of surgery for obesity are still relatively
new. Therefore, the long-term results of such surgery, including weight loss or
possible complications, are unknown at this time.
I have read the above two pages of information, all of which has
been described and explained to me by my surgeon. I understand this material,
the risks, possible complications, other choices, and the possible benefits of
obesity surgery, as well as the operation which the surgeon recommends for my
case.
By signing the statement, I am showing that I have read and that I accept the
above, and that I understand it. I have been encouraged to ask all the
questions that I wanted, which have been answered thoroughly and to my
satisfaction. I understood the answers well.
Patient signature ________________________
Date ___________________________________
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