I don't know, but I'm sending this out to the:
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.
"How does a 450-pound woman become pregnant?"
Someone offered her candy in return for her favors??
Took the question right outa my head, you did.
She had the surgery 10 months before she got pregnant. This happened 18 months after the surgery, when the fetus was at 8 months.
I just learned once again about the procedure a bit too close for comfort. A colleague had it back in the mid-1980's. Beautiful lady, who wanted to save her marriage. She was never the same again, with continual health problems thereafter.
Two weeks ago, the 2nd person I ever knew to have the procedure died. Went into the hospital with such confidence and such hope about conquering the weight once and for all. Experienced e-coli, then septicemia, then gangrene. The family had the life support pulled yet death did not occur until two days after that. It must have been so painful.
Please caution anyone you know to get a second and a third opinion. The risk does not seem to be worth it.
Just one little annoyance: the article keeps referring to the "fetus." That, of course, is the language used to dehumanize babies in order to kill them with less guilt.
Otherwise, very sad situation. There are no easy fixes for a weight problem, but there are too many people who want to take a magic pill, or have a magic surgery to get rid of the weight effortlessly. Losing weight takes work. I know. I once weighed 70 pounds more than I do now.
I wonder how many people have died or suffered debilitating complications as a result of plastic surgery? Liposuction, breast implants, butt imlants, etc.
Wow. I'm glad you are your daughter are okay.
Didn't bother to read the article did you?
Thank you, and we both are! She'll be eleven years old in September.
Since the start of 2003, three other Massachusetts patients have died after gastric bypass, and the state is developing guidelines to increase safety.
Wouldn't it be easier for fat people to just exert a little self-discipline (or a lot) and prevent all that pie from entering the pie-hole in the first place?
I'm curious: what was the cause of your obesity determined to be? I should have read down some before making my previous insensitive remark...
Bump for later.
Just one more thing: I am about fifty pounds (my estimate) overweight, but there's no way in heck I would consider having surgery. Hopefully, more exercise and self-discipline will get me squared away...
The sugery was 18 months prior BEFORE she got pregnant.
In one word: GENETIC.
I was overweight when I was born and continued to be throughout my entire life, regardless of what I ate or how hard I exercised. My gastric bypass surgeon measures intestinal length when he does the surgery. Normal small intestines are 19-22 feet long. Mine were 40. "You could eat sand and still gain weight," he told me in the recovery room.
The only drawback to finding out that piece of information is that you have to be opened up to find that out!
I wish you nothing but the best. Fifty pounds is manageable though difficult...150 is another matter.
What a lot of people don't realize is that morbid obesity causes excessive wear and tear on your joints including your feet, hips, ankles, knees and especially your lower back. Even though I'm a very comfortable weight today (OK, I wouldn't mind losing another 15-20 pounds, but who wouldn't?), I have chronic bursitis and tendon problems because of the weight. It makes exercise painful and takes a lot of time to get the flareups to calm down. When you're morbidly overweight, excercise is a nightmare.
I do apologize for my insensitivity.
Thank you :-)
Nobody wants to be obese, and once you get to a certain point it becomes more and more difficult to lose weight because of gravity. I know I can't be the only exception to the rule and there are a lot of people who battle the buldge because of genetic factors. I just wish that some so-called medical professionals would realize that the social stigma of being obese is a major stress factor - which makes you want to eat!
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.