Posted on 08/14/2004 5:15:17 PM PDT by neverdem
THE ASSOCIATED PRESS
An obese Massachusetts woman and her 8-month-old fetus died of complications 18 months after the woman had stomach-stapling surgery, an apparent first that is leading to warnings about the risks of pregnancy soon after the surgery.
The deaths, in 2002, raise concerns because most of the 110,000 people who have gastric, or stomach, bypass surgery each year in the United States are women in their child-bearing years, say doctors at Brigham and Women's Hospital in Boston who tried to save the woman and fetus. They reported on the case in a letter in Thursday's New England Journal of Medicine.
Dr. Edward E. Whang cared for the 41-year-old woman nearly two years ago, when she was brought to the Brigham emergency department after two days at another hospital, where the cause of sudden pain in her upper stomach had been misdiagnosed.
"She was nearly dead," said Dr. Whang, who noted the woman had the gastric bypass and prenatal care at other hospitals.
After tests and symptoms indicated an infection, Dr. Whang did emergency surgery. He found most of the woman's small intestine had slid through a hernia, or tear, in an adjacent membrane, a defect sometimes left after the intestines are rearranged in the bypass operation. The hole choked off blood to the stretch of intestines, and the tissue turned gangrenous.
By then the fetus had died. Dr. Whang repaired the intestine, but the woman died within a few hours. She still weighed 440 pounds; her original weight was not available.
"This is a tragic case, but you need to look at the overall risk-benefit of the surgery," said Dr. Harvey Sugerman, president of the American Society for Bariatric Surgery, an educational group for obesity surgeons.
Dr. Sugerman said three studies showed extremely obese patients had death rates as much as five times lower if they underwent gastric bypass surgery, compared with those who do not. And other research shows lower rates of pregnancy complications after the weight-loss surgery.
He estimated that more than 110,000 gastric bypasses would be done in the United States this year. Complications strike as many as 1 in 5 patients, and it is believed that for every 200 patients, 1 to 4 will die.
Dr. Sugerman and other doctors said they knew of no other woman-fetus deaths after the operation.
But Dr. Whang said about 85 percent of gastric bypasses were performed on women, most of child-bearing age. He advised any pregnant patients with sudden pain to see a bypass expert quickly.
"Most doctors recommend contraceptives for two years after the surgery" to avoid pregnancy until the woman's weight stabilizes, said Dr. Sattar Hadi, who runs the high-risk obesity clinic at Vanderbilt University's Center for Human Nutrition. Doctors say the procedure decreases the nutrients available to the fetus and, as in the case of the Massachusetts woman, can lead to serious infections.
Dr. Hadi said it was unclear whether the woman's hernia was due solely to the surgery "or the fetus pushing onto the intestines."
Dr. Mark Tucker, director of bariatric surgery at the University of Medicine and Dentistry of New Jersey in Stratford, said such hernias were not uncommon and could happen up to five years after the surgery. Because fertility increases with major weight loss, he said, reports of pregnancies within a year of surgery are becoming more common.
In standard gastric bypass surgery, a small pouch at the stomach's top is separated from the rest using staples. Moving down the small intestine a few feet, the surgeon then cuts it in two, pulls the bottom segment up and attaches it to the new pouch. The dangling upper segment, which carries digestive juices, is then reattached to the lower segment.
Patients then lose weight because the new pouch holds a few ounces of food at a time, and some calories and nutrients are not absorbed because the food bypasses much of the stomach and small intestine. Patients must take protein and vitamin supplements to avoid malnutrition.
Since the start of 2003, three other Massachusetts patients have died after gastric bypass, and the state is developing guidelines to increase safety.
The federal Medicare program has paid for stomach bypass surgeries for a few years, but only in people with related medical conditions such as diabetes. It covered 7,801 operations in 2003, about double the number in 2001.
Dr. Steve Phurrough of the Centers for Medicare and Medicaid Services said the agency recently ruled obesity could be considered an illness on its own, so an advisory panel this fall is to recommend whether Medicare should cover the surgery in people without related conditions. Dr. Phurrough expects the panel to urge waiting until there is more research on the surgery on the elderly.
"We have significant concerns about the risks," he said.
ping
Is there really a stomach-stapling ping list??
> ... it is believed that for every 200 patients, 1 to 4 will die ...
The only person I ever knew to have elected this,
died on the table. Just a single anecdotal data
point, to be sure, but hardly encouraging.
Dietary modification is vastly safer.
If it doesn't go in, it can't go on.
And in my experience, eating "balanced"
(40-30-30), also eliminates craving.
How does a 450-pound woman become preganant?
Plus some tequila.
Don't most women get pregnant the same way?
In June, 1992 I had a gastric bypass. I was 27 years old, married, had a 2-year old son and weighed over 300 pounds.
The following January, after loss over 100 pounds (I was still losing at the time) I got pregnant.
When I was about 3 months along I got a hernia, which next to childbirth was probably one of the most painful things I've ever experienced. My symptoms were very similar to this poor woman in this story -- I had an "incarcerate" intestine. I was on the table in the emergency room and about to undergo emergency surgery to fix it when the pain medication they gave me finally relaxed my muscles enough to allow it to be pushed back in. My wonderful bypass surgeon consulted with my OB/GYN, and they rigged a "truss" for me, which I had to wear until I was about 7 months pregnant. At that time my daughter was developed enough to close off the opening.
Shortly after she was born the hernia was back. I was 9 weeks post-partum when I had it repaired.
Not an easy thing at all, but 11 years later I still don't regret my bypass surgery. All it takes is the common sense to see a DOCTOR when something goes wrong, regardless of the cause.
With beer? No, but seriesly, she may have been an absolutely wonderful woman, and her husband deeply in love with her, but it just seems physically impossible. Maybe I'm just narrow-minded.
...LOTS of tequila...
I read a book about dieting, and one chapter was on this gastric bypass surgery.
Most of the problems occur after the surgery, sometimes years after. That is when you start to see malnourishment and sometimes even the organs will begin to shut down.
I was (and have for most of my life) struggling with my weight some years ago and was actually looking into this procedure. I described it to my husband and his response was, "absolutely not".
I wonder what size the husband is --- I think it would be harder if he was also on the real big side.
8 months is a BABY murdered by a stupid greedy doctor and a selfish self-serving idiot "mother"
BEER GOOD!
MORE BEER...BETTER!
My first clue this might not be a panacea was that it required the words "stomach" and "stapled" in the same sentence. ;-)
LOL, no, but I have me umble health and science ping list. Are you interested?
I assume the "stupid greedy doctor" is the surgeon who performed the Gastric Bypass surgery?
the "stupid greedy doctor" is the surgeon who performed the Gastric Bypass surgery
You got it!
Performing radical surgery designed to STARVE a person while she is near term could only have one result --- DEATH of the BABY!
The mother's death - I do not feel for her at all. She held the ultimate responsibility for the safety of her child and she failed --- miserably.
Please reread the article. Pregnancy lasts 9 months. The woman died in her 8th month of pregnancy 18 months after having surgery. Therefore, she had the surgery 10 months prior to her even getting pregnant. The surgeon had no fault in this, and the baby was not "killed" by anyone. You might want to read more carefully and have your facts in order before you go off on a rant like this.
If she had not had the surgery it still would have been a very high risk pregnancy given her weight and her age.
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