**Title: The Safety of Bariatric Surgery: Exploring Risk Factors and Emerging Alternatives**
**Introduction**
Obesity continues to be a significant health concern worldwide, and bariatric surgery has emerged as an effective intervention to promote weight loss and improve overall health outcomes. However, the recent death of singer-songwriter Lisa Marie Presley due to complications related to bariatric surgery has raised questions about the safety of these procedures. In this article, we will delve into the risks associated with bariatric surgery, explore potential factors contributing to complications, and discuss emerging alternatives in the field of obesity treatment.
**Understanding Bariatric Surgery**
Bariatric surgery encompasses various procedures aimed at reducing the size of the stomach or altering the digestive system to limit food intake and nutrient absorption. These procedures often lead to significant weight loss and improvements in obesity-related comorbidities such as diabetes, cardiovascular disease, and certain cancers. However, as with any surgical intervention, bariatric surgery carries certain risks.
**Risks Associated with Bariatric Surgery**
1. Short-term Risks:
– Leakage, bleeding, infection, and blood clots are possible complications immediately following surgery.
– Mortality rates are currently less than 0.1%, while major complication rates range from 1% to 4%.
2. Long-term Risks:
– Intestinal obstruction and malnutrition are potential long-term complications.
– It is crucial for patients to take multivitamins and adhere to recommended dietary guidelines to reduce the risk of malnutrition.
**Factors contributing to Complications**
While bariatric surgery has become safer due to advancements in techniques, complications can still occur for various reasons. It’s essential to consider individual patient factors, surgical techniques, and the type of procedure when assessing the risks.
1. Internal Scarring:
– Scar tissue formation can occur after any surgery, including bariatric procedures, leading to bowel obstructions. These adhesions can restrict blood supply, ultimately resulting in severe complications.
– The association between Presley’s death and internal scarring from bariatric surgery has been questioned by some surgical experts.
2. Alternative Surgeries:
– Intestinal obstructions can occur after many types of surgical procedures, not just bariatric surgery. Gynecologic, urinary system, and general abdominal surgeries can also lead to internal scarring and subsequent complications.
3. Surgical Techniques:
– The majority of bariatric procedures are now performed using minimally invasive techniques, such as laparoscopy, which reduces scarring compared to open surgeries.
– Laparoscopic bariatric surgery has significantly reduced the risk of bowel obstructions, occurring in only 1-2% of patients long-term.
**Emerging Alternatives to Bariatric Surgery**
1. Anti-Obesity Medications:
– Obesity drugs like Wegovy and off-label use of Ozempic have gained popularity as non-surgical alternatives.
– While these medications can be helpful, they often do not achieve the same degree of weight loss as surgery.
2. Lasting Effects of Surgery:
– Bariatric surgery offers a lasting approach to treating severe obesity, as the changes from surgery are more permanent compared to medications that require ongoing use.
– Surgery mimics the hormonal changes in the gut that contribute to weight loss and appetite control.
3. Individualized Decision-making:
– The choice between anti-obesity medication and bariatric surgery should be based on individual patient factors and a thorough discussion between the patient and their healthcare provider.
– Factors such as the amount of weight loss required for improved health must be considered.
**The Importance of Obesity Treatment**
Although the risks associated with bariatric surgery cannot be ignored, it is crucial to emphasize the overall benefits of obesity treatment. Obesity is a chronic disease that increases the risk of various health complications, including cardiovascular disease, diabetes, and certain types of cancer. Bariatric surgery has been proven to significantly reduce the risk of these conditions and improve long-term outcomes.
**Discussion and Conclusion**
While the recent tragedy involving Lisa Marie Presley’s death has raised concerns about the safety of bariatric surgery, it is essential to consider the broader context of obesity treatment. Bariatric surgery, when performed appropriately and with careful patient selection, remains a safe and effective option for individuals struggling with severe obesity. Nonetheless, proper counseling and patient education about the risks and benefits of bariatric surgery are crucial to make informed decisions.
As research continues to advance, alternative options such as anti-obesity medications are gaining attention. These medications offer promising results but may not match the degree of weight loss achieved with surgery. Ultimately, the choice between surgery and medication should be individualized and based on a thorough evaluation of each patient’s unique circumstances.
It is vital to recognize that obesity is a complex disease with multifactorial causes. Comprehensive treatment approaches, including lifestyle modifications, behavior therapy, and medical interventions, should be considered to address both the physiological and hormonal aspects of weight management. The growing conversation about obesity, driven by the popularity of medications like Wegovy and Ozempic, can help reduce stigma, raise awareness, and promote a more comprehensive understanding of this significant health issue.
In summary, while bariatric surgery carries certain risks, it remains a valuable intervention for individuals with severe obesity. Emerging alternatives, such as anti-obesity medications, provide additional options but must be carefully evaluated in the context of each patient’s unique needs. By continuously advancing research and promoting comprehensive treatment approaches, we can effectively address obesity and improve the health outcomes of millions of individuals worldwide.
**Summary**
The recent death of singer-songwriter Lisa Marie Presley due to complications related to bariatric surgery has sparked concerns about the safety of these procedures. While bariatric surgery carries certain risks, it remains a valuable intervention for individuals with severe obesity. Internal scarring from previous surgeries, including bariatric procedures, can lead to bowel obstructions, but alternative surgeries and surgical techniques also pose risks. Emerging alternatives, such as anti-obesity medications, offer promising results but may not match the weight loss achieved with surgery. Ultimately, the choice between surgery and medication should be individualized based on thorough evaluation. Obesity is a complex disease, and comprehensive treatment approaches encompassing various therapies should be considered. By advancing research and promoting comprehensive understanding, we can effectively address obesity and improve the health outcomes of individuals worldwide.
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July 17, 2023 – Singer-songwriter Lisa Marie Presley died of a “strangled” or twisted small intestine on January 12, shocking many fans who had seen her attend the Golden Globe Awards ceremony just a few days before. The daughter of the late Elvis Presley was 54 years old.
The Los Angeles medical examiner ruled that Presley died of natural causes and, in a report released last week, linked his small bowel obstruction to bariatric surgery he had years earlier. CNN, which first obtained the autopsy, said it included the official opinion of Assistant Medical Examiner Juan M. Carrillo, MD, who said the blockage was caused by “adhesions (or scar tissue) that developed after bariatric surgery years ago.” . This is a known long-term complication of this type of surgery.”
Surgical experts do not dispute that a cut in the blood supply to her small intestine, also known as the small intestine, led to her death. But they’re not so sure that internal scars from previous weight-loss surgery are to blame.
“It just doesn’t make exact sense to all of us. [surgeons]said Marina Kurian, MD, president of the American Society for Metabolic and Bariatric Surgery. “It looks like she had an intestinal obstruction for sure. But it’s not clear to me… that it’s related to bariatric surgery, because those scars would be right on the liver and the stomach, and the small intestine is not usually there.”
Presley reported belly pain earlier that day, according to the medical examiner. It is not clear if his pain had persisted for days or came and went in severe episodes, which are common signs of intestinal obstruction. vomiting and abdominal distension – when air or fluid accumulates in the belly and causes it to expand – are also common.
In many cases, intestinal obstructions can be treated if medical attention is sought early enough. “Obviously the message is if you have abdominal pain and it’s persistent abdominal pain, go see a doctor,” Kurian said.
Not all bariatric procedures are the same
Bariatric surgery includes many different procedures, and based on the medical examiner’s report, Kurian believes that Presley most likely had a single anastomosis duodenal ileostomy (SADI). This type of procedure reduces food intake by reducing the size of the stomach and limits food absorption by bypassing part of the small intestine.
A bowel obstruction can occur after many types of surgery, not just bariatric procedures. Gynecologic surgery, urinary system surgery and general abdominal surgeries can leave internal scarring that causes this complication, Kurian said. “So it very well could have been from some other surgery.”
If left untreated, intestinal obstructions can cut off the blood supply, “which is what unfortunately happened in Ms. Presley’s case,” said Stacy Brethauer, MD, a bariatric surgeon and professor in the Division of Gastrointestinal and General Surgery. from Ohio State Wexner University. Medical Center.
Nearly all bariatric procedures in the past two decades have been performed with minimally invasive techniques, such as laparoscopy, which leave less scarring than open surgery, Brethauer said.
“Fortunately, bowel obstructions are quite rare now after laparoscopic bariatric surgery, occurring in only 1-2% of patients long-term,” he said.
Short and long term risks
In general, the risks of poor outcomes after weight-loss surgery are “very, very low,” Kurian said. Short-term risks include leakage, bleeding, infection, and blood clots. Long-term adverse effects may include intestinal obstruction and malnutrition. The risk of malnutrition from decreased nutrient absorption can be reduced if patients take multivitamins, for example.
For the vast majority of patients who seek bariatric surgery, the benefits far outweigh the risks, both in the short and long term, Brethauer said. The benefits include a significant reduction in long-term deaths, the risk of cancer, cardiovascular disease, and diabetes.
“Doctors should counsel patients that bariatric surgery, like any surgical procedure, has some inherent risks,” he added. Mortality rates are currently less than 0.1%, and short- and long-term major complication rates range from 1% to 4%.
Risks also vary depending on individual patient factors and the type of bariatric procedure, such as sleeve gastrectomy, Roux-en-Y gastric bypass, or adjustable gastric banding.
If the association with bariatric surgery was behind Presley’s death, “it’s very important to summarize how safe bariatric surgery really is. We get the majority of people through surgery ‘well, healthy and abundant,’” Kurian said.
Anti-obesity drugs versus surgery?
When asked whether the growing popularity of obesity drugs like Wegovy or the off-label use of Ozempic will slow down weight-loss surgery, Kurian was dubious.
“Bariatric surgery, actually, I don’t think it will go away,” he said. “These medications are helpful, but the ones we currently have haven’t taken as much weight off as surgery.”
Kurian believes that surgery offers a more lasting approach to treating severe obesity.
Ultimately, a decision about anti-obesity medication and/or bariatric surgery must be individualized and based on a discussion between the patient and their doctor. It also depends, in part, on how much weight a person would need to lose to become healthier, Kurian said.
“These drugs are a fantastic addition to our armamentarium for the treatment of obesity,” said Brethauer. “These injectable drugs actually mimic the same changes in gut hormones that we see after metabolic procedures like gastric bypass, sleeve gastrectomy, and duodenal switch.
“Both bariatric surgery and pharmacological agents such as GLP-1 receptor agonists are safe and effective, and we use these medications before and after surgery to promote additional weight loss and control hunger,” Brethauer added. The biggest difference between the two approaches is that the changes from surgery are more permanent compared to medications that need to be taken on an ongoing basis.
On the bright side, more people are talking about obesity with the popularity of Wegovy, Ozempic, and other anti-obesity drugs. This could help remove some of the stigma around obesity, Kurian said, and “makes everyone realize that it’s not just about diet and exercise.”
“It’s wonderful that people are being helped to understand … that it’s not just their failure, but that there are physiological and hormonal reasons for not being able to lose weight easily.”
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