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 The
death of an obese woman and her unborn child underscores the concern
many health professionals have about the risks of pregnancy so soon
after having gastric bypass surgery. The deaths, reported two years
ago, were the first suffered by a woman and an unborn child due
to complications from such surgery.
The big concern: Women make up the majority of the 110,000 people
who have gastric bypass surgery, largely during their child-bearing
years.
The 41-year-old woman was brought to Boston's Brigham and
Women's Hospital after she spent two days in another hospital
that had misdiagnosed the cause of the sudden pain in her upper
stomach. Doctors did emergency surgery after an infection was found.
Most of the woman's small intestine slid through a tear in
an adjacent membrane, a problem that can remain after these organs
are moved during bypass surgery. The hole eventually stopped the
flow of blood to the intestines turning them gangrenous.
Although surgeons repaired the woman's intestines, the damage
was already done. Her unborn baby was already dead and the woman
died shortly after surgery.
At the time of death, the woman weighed 440 pounds.
Despite this tragic "first," some gastric bypass experts
contend recent studies showed the mortality rate for the morbidly
obese was five times lower if they opted for the surgery -- as well
as fewer complications for women during pregnancy -- compared to those
who didn't.
More number-crunching behind gastric bypass:
- About 20 percent of the patients who choose gastric bypass surgery
will suffer complications
- An estimated 1 to 4 out of every 200 patients will die from
those complications
- Eighty-five percent of all gastric bypass surgeries are done
on women, primarily during their childbearing years
- Tears or hernias weren't uncommon, experts say, and could
happen up to five years after surgery
Because the surgery lessens the number of nutrients available to
a fetus and can lead to serious infections, many physicians prescribe
contraceptives for two years after the surgery to avoid pregnancy
until a woman's weight stabilizes. Also more common are pregnancies
a year after the surgery because fertility rises with a major weight
loss.
How gastric bypass surgery works: The surgeon separates a small
pouch at the top of the stomach with staples from the rest. He or
she then cuts the bottom segment of the small intestine and attaches
it to the newly stapled pouch. The upper part of the stomach that
holds digestive juices is reattached to the lower part.
Because the "new" pouch holds just a few ounces of food,
calories and nutrients aren't absorbed into the small intestine,
meaning people lose weight. But they also have to take supplements
and protein to guard against malnutrition.
Because three more patients in Massachusetts have died due to gastric
bypass complications in the past 20 months, the state is considering
new safety guidelines.
Springfield
News-Leader August 24, 2004
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