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Thursday, July 19, 2007

Hullah over Bariatric Surgery Deaths

The Times of India, I was told in hushed whispers, has run a story on some deaths that have occured in Indian patients who had undergone bariatric surgery. As I said in my last post, WTF? I mean "Why The Fuss?"
Bariatric surgery is a science that causes massive weight loss in severely obese patients. There are a few types of these, which work by reducing the amount of food that the person can eat, and by preventing full digestion and absorption of ingested food. The commonest operations are the Gastric Bypass and the Lap Band.
Now, these operations, done by the popular keyhole (laparoscopic) method, are rather painless and allow rapid return to home and the workplace. Plus there IS weight loss: big time (70% of excess body weight)!
Now this boring medical, technical-kinda blogpost takes an interesting twist: bariatric surgery does cause fatality. There is a known complication rate. But why should it hit the papers? I have known of this happening in virtually every city in the world where bariatric surgeries are done, and there is always a big ruckus, and then things go back to normal again. Why?
Bariatric Surgery has been hyped up by the surgical industry. It's the truth, and there's no trying to escape that. The media is always fed stories on the positive aspects of the story, but since there is little point in dampening the enthusiasm of prospective patients, the complications are rarely dealt with. And WE, the surgeons, are guilty of this. I, too, have written about this, and not just once.There has been brand-selling in the name of awareness-building. And, of course, the surgical products industry is solidly behind the initiative. These are truths. You may argue over the ethics of it, but good work does get done because of the awareness building, patients do lose weight and get cured of their diabetes and high blood pressure, and surgeons do get their next big car or mistress, and their children do go to elite schools that wipe your bank accounts clean like Coke does to toilets. But, among the positives, there is a stain of the ugly, and the faint stench of death. Surgeons may underplay the issue of complications of bariatric surgery, resulting in a high level of expectations on the side of the patients. So, whenever a death occurs, there is a jolt, a jhatka. The ensuing agitation reaches the media, and there is hullah. After a while, things become normal when the positive spin starts the next cycle. After all, obesity is always a hot topic.
And, you know what, I do bariatric surgery. I make it a point to balance the hype of the positive endpoints (weight loss, improved outlook in life, etc.) with the possible complications and the mortality risks. Because I speak candidly ("Of course, one can die after this surgery, being in a special high risk group"), I don't get too many of these onto the operating table. But then, my fat is not on the fire, neither! That is, at least, one good thing to say about being a poor surgeon!


Sree's Views said...

very upfront post!
Even 'thayir vadais' enjoy these 'oyster' blogs ;)
good write up, doc !

B. Ramana said...

Thanks for the curdesy, Sree! :-)