Real Complications Rate, and how to "Stack the Deck"

[ouroborous 519]

So, I'm about five weeks out from surgery -- May 6th.

For reference, I'm a 39 y.o. male, BMI 42 (6'1, wt. 330). My cardiac scans were good, I'm going for an EGD on Thursday due to concerns about GERD and some upper right quadrant pain that could be gall bladder, but is more likely due to my enlarged liver.

I have been diagnosed with fatty liver (without scarring, thankfully), but my liver enzymes are normal. My surgeon suspects that my upper right quadrant pain (it is very mild and intermittent) is the enlarged liver pushing against the "capsule" that it sits in. Hopefully with weight loss, this problem will resolve itself. I'm in generally good health otherwise -- I have sleep apnea, as you'd expect for someone who is 120 pounds overweight, but no diabetes or cardiopulminary issues. Aside from some recurrent allergies, sinus infections, I think I'm in decent health (for an obese man).

So here's my question. I'm a worrier -- I worry (needlessly, most likely) about post-operative and perioperative complications. I know that my anxiety is normal and not the end of the world, but I'd like to know:

1. What is the real complication rate associated with VSG? I know that general anesthesia always carries risks, but these are generally small. What are the chances of leaks and so on? My doctor (Dr. Robert Landerholm in WA state) has performed "hundreds" of VSG's with "one" leak (due, he said, to patient noncompliance), so I'm hoping that surgeon competency isn't an issue.

2. What can I do now, in the month leading up to surgery, and after surgery, to increase my chances of a successful, complication-free operation? I suspect that with an already-diagnosed fatty liver, the pre-op diet is going to be crucial. I'm also going to start doing cardio work every single day to make sure my heart and lungs and immune system are as strong before the operation as I can make them. Is there anything else I can or should be doing?

[MINI-Me 196]

Just talk with Dr. L and Melanie - the nutritionist. They will take good care of you.

[ouroborous 519]

Just talk with Dr. L and Melanie - the nutritionist. They will take good care of you.

Thanks for the advice, but I was hoping one of the RN types around here had some more hard advice. I can't access Dr. L every day, whereas this forum is pretty responsive!

[thinoneday 445]

Health care reform hasn't quite kicked in yet! Free isn't available yet . . .hehehehehe. . . good luck

Edited April 1, 2010 by thinoneday

[pumpkin07 32]

I know it is real scarey. I am sure an RN might respond, but I'd say make sure you get your Water both before and after surgery. I got dehydrated, perhaps was dehydrated when I went into surgery, which made my IV difficult and can lead to clotting.

Also you could just make certain you truly have an excellent doctor. They can be Centers of Excellence and not be excellent. You should be able to see a lot of reviews on line.

[Lisalu 89]

I hope someone answers your questions soon. I too am a worrier and have wondered the same thing.

[Stacy160 201]

Also you could just make certain you truly have an excellent doctor. They can be Centers of Excellence and not be excellent.

In the same vein, they can also be excellent but not be "Centers of Excellence", which is a title I'm sure they have to pay for in some way. :lol0:

[Tiffykins 673]

Across the board for leaks, I think it's generally 1-2% for leaks.

It takes months to shrink a true fatty liver, but the pre-op diet will definitely help get rid of the slippery fatty deposits on the outside of the liver which will help the surgeon move it out of the way to get to your stomach with the liver retractor.

Start chewing slower, sitting your utensil down in between bites, half your portions, and eat your Protein first, take a minimum of 20-30 minutes to eat your meal and then see if you are full/satisfied with smaller portions, steer clear of white carbs, take a good quality multi Vitamins, destress as much as you can because stress slows healing, stick to the post-op diet don't progress it early just because you feel "good", mentally prepare yourself for the many changes that immediate follow surgery, and have faith in your surgical team and more than anything, have faith in yourself and your ability to succeed.

[ouroborous 519]

Across the board for leaks, I think it's generally 1-2% for leaks.

Okay, this is exactly what I'm hearing from all sources, so it rings true. 1-2% is not really something to worry about, since I think that's about the same as the general anesthesia complications rate. So if you're going to worry about THAT...

It takes months to shrink a true fatty liver, but the pre-op diet will definitely help get rid of the slippery fatty deposits on the outside of the liver which will help the surgeon move it out of the way to get to your stomach with the liver retractor.

Ahh, this makes sense. I was under the impression that real liver "shrinkage" just couldn't really happen in two weeks. The slippery liver thing makes more sense.

Start chewing slower, sitting your utensil down in between bites, half your portions, and eat your Protein first, take a minimum of 20-30 minutes to eat your meal and then see if you are full/satisfied with smaller portions, steer clear of white carbs, take a good quality multi Vitamins, destress as much as you can because stress slows healing, stick to the post-op diet don't progress it early just because you feel "good", mentally prepare yourself for the many changes that immediate follow surgery, and have faith in your surgical team and more than anything, have faith in yourself and your ability to succeed.

Yeah, this will be the hard part for me! I'm naturally a worrier :lol0:

Thanks for the info, as always!

[LisaaaLisaaa 8]

I'm a worrier too and this information is very helpful. I'm scheduled for surgery January 5th and I've been scared and nervous and worried since they told me the date. Lisa

[TKeith 0]

I'm getting sleeved January 11th in Grand Rapids Michigan. Nervous and excited too!

I'm a worrier too and this information is very helpful. I'm scheduled for surgery January 5th and I've been scared and nervous and worried since they told me the date. Lisa

[thinoneday 445]

I don't know if this will help anyone out there but I like to share my story a bit with you. . . on December 29th i will be out 1 year! I've lost a total of 140 + lbs, and can't even imagine how many inches. . . I 've gone from a snug 4XL to a L in uniforms and from 32 W to 14/16W in jeans and dress pants. . . Folks I LOOK GOOD!!!! This was my 18th major surgery and with each surgery I have been nervous and anxious (im highly allergic to ALL narcotics and have to deal with surgical pain in different ways. I use diversion) . . the feelings are normal but you know what? I'm still here! My specialists call me the "hollow one" :lol: Some doctors humor is really different huh? But its funny! So I'm hoping this brings a bit of comfort to those out there who are worriers and to those who are just plain old nervous about it all. . . it's just a few hours long and the next thing you know YOUR LOOKIN MIGHTY FINE!!!!

[bugwitch 37]

I would recommend visiting your local library (public or university) and asking how to use their online journal sources. Look up professional journals (Obesity Surgery, etc) and then do a variety of searches. You will get a bunch simply discussing new technique, etc. But others which are specific to your question will be there as well. I am a grad student and wouldn't you know it, instead of using my university resources for being productive (student-wise) I've been spending all of my time searching online journals and other sites for just this sort of stuff.