As bariatric weight-loss procedures have become increasingly popular, I have handled more and more bariatric surgery cases in my law practice as a Houston, Texas medical malpractice attorney.
Over the years, some procedures became widely used, only to later fall from favor. One of the first bariatric surgery malpractice cases that I handled involved such a procedure, gastric imbrication. Gastric imbrication seems to be rarely used these days.
Weight-loss surgical goals and common procedures
Broadly speaking, weight-loss surgeries have one or two goals in mind. The first is restriction, or physically limiting the amount of food the stomach can hold. The second goal is malabsorption, or surgically modifying the way food passes through the gastrointestinal system by shortening or bypassing the small intestines.
Currently, the four most common types of bariatric surgery include Roux-en-Y gastric bypass, laparoscopic gastric banding, sleeve gastrectomy, and duodenal switch with biliopancreatic diversion.
Bariatric surgery benefits
In my experience from handling many bariatric surgery cases, both advertising and physician or nurse conversations with patients focus almost exclusively on the benefits of bariatric surgery, to the near-total exclusion of the significant risks.
Medical research and literature are clear that there are true benefits of weight-loss surgery for many patients. A December 2017 study published in the Journal of the American Medical Association (JAMA) Surgery looked at how patients were doing seven years after bariatric surgery.
Generally, the health benefits that are touted in the bariatric industry include weight loss, elimination or better control of diabetes, and reduction of cholesterol levels. The study considered both of these factors.
According to the study, after seven years, for Roux-en-Y gastric bypass patients the mean weight loss was 28.4% with weight regain after three years of 3.9%. During the same timeframe, the results for laparoscopic adjustable gastric banding patients were 14.9% mean weight loss with 1.4% weight regain.
The study found a reduction of high cholesterol levels (dyslipidemia) at the seven-year mark for both Roux-en-Y gastric bypass and gastric banding patients.
On the issue of diabetes, 60.2% of gastric bypass patients and 20.3% of gastric banding patients had remission of diabetes seven years after their weight-loss procedures.
The study concluded that bariatric surgery leads to different weight-loss patterns, but that most patients in the study maintained much of their weight loss, with some long-term fluctuations.
Bariatric surgery risks
Based on the cases that I have handled, it is clear to me that there is a wide variation in the experience and competence of surgeons in handling complications of weight-loss surgery. In other words, some surgeons are capable of performing bariatric procedures, but are rather incompetent at addressing or fixing any complications.
I suspect that it is a bit of a numbers game. Bariatric surgery is highly advertised and many of the surgical practices are operated in an assembly line fashion. Numerous clients have told me that their surgeons would have group meetings between a surgeon or nurse and several patients to go over informed consent and pre-surgical paperwork, and to answer any questions. The same is true for post-operative follow-up appointments.
Before I went to law school, I was a hospital administrator. In quality of care committee meetings, and other interactions with doctors, I remember hearing several times the saying that “common things happen commonly.” Bariatric surgeons are used to running lots of patients through their office practices and operating rooms. Some of them get so used to keeping the line moving that they don't pick up on serious complications, until it's too late.
The problem with bariatric surgery is that when things go wrong, they can go terribly wrong. After all, bariatric surgery involves a dramatic alteration of the body’s normal anatomy.
Common complications that I have seen, in medical malpractice lawsuits that I have filed, include gastric outlet obstruction and strictures. Both of these conditions prevent food or liquid from passing through the gastrointestinal tract and can lead to severe malnutrition, and even malnutrition-related brain injury from conditions like Wernicke’s encephalopathy, which is caused by a severe vitamin B deficiency.
In these types of cases, my clients reported that they experienced severe pain, nausea, and vomiting that persisted for days or weeks following their weight loss surgery. Instead of investigating the cause of these concerning symptoms, their surgeons commented that each patient responds to the procedure differently.
While this is true, and there is a normal range of pain tolerance, nausea, and vomiting, it violates the standard of care when the surgeon does not rule out a more serious cause. Radiology testing is helpful and useful, including studies like a barium swallow, gastrografin, and abdominal CT scan.
Surgical experts that I have hired to review bariatric surgical malpractice cases have shared their opinion that when there is an abnormality on a post-operative diagnostic radiology study, the safest thing to do is return the patient to the operating room to address the problem. Unfortunately, some surgeons take a “wait and see” position for such complications, and can leave patients in a compromised, life-threatening status.
What you can do
If you are considering a weight-loss procedure, I recommend that you do some research on potential surgeons. Look into the surgeons’ medical school education, as well as residency and fellowship training. Ask the surgeons about their specific training and experience in performing the specific procedure that interests you. Inquire about the surgeons’ complication rates and whether they handle complications themselves or refer their patients to a specialist.
During the deposition of a bariatric surgeon, and one case that I handled, I was surprised to learn that his formal training for handling the weight-loss procedure at issue was limited to a weekend course in Tijuana, Mexico.
If you or a loved one has been seriously injured as a result of medical malpractice in a bariatric weight-loss surgery or follow-up care, call Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation about your potential case.
Robert Painter is a medical malpractice and wrongful death attorney at Painter Law Firm PLLC, in Houston, Texas. He focuses his practice on representing patients and family members and lawsuits against hospitals, surgeons, doctors, pharmacies, and other healthcare providers.