Gastric banding – why surgery should always be the last resort

Posted: 01/08/2014

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With the cost to the NHS in England for treating diseases associated with obesity estimated to rise to £6.3 billion by 2015, obesity not only threatens the health of individuals but also has an increasingly negative impact on society.

As gastric banding (bariatric surgery) grows in popularity, the Penningtons Manches cosmetic surgery claims team looks at the benefits and risks of this ‘last resort’ weight loss option.

Weight loss surgery is used to treat people who are dangerously obese and is only available on the NHS to treat people with potentially life-threatening obesity when other treatments such as lifestyle changes have failed.

The NHS defines ‘potentially life-threatening obesity’ as having a body mass index (BMI) of 40 or above or having a BMI of 35 or above and having another serious health condition such as type 2 diabetes or high blood pressure which could be improved by losing weight.

The National Institute for Health and Care Excellence (NICE) recommends that weight loss surgery should only be offered on the NHS if all the following conditions apply:

• you have tried all the appropriate non-surgical methods such as diet and exercise but have failed to achieve or maintain a beneficial level of weight loss for at least six months
• you agree to commit to long-term follow-up treatment after surgery at a specialised obesity service
• you are fit and healthy enough to withstand the anaesthetic and surgery

Some experts are warning that obese people are increasingly opting for a ‘quick fix’ in spite of the risks inherent in surgery rather than seriously attempting to lose weight and without fully exploring the other options. They are often being encouraged to do so by the private medical sector.

Bariatric surgery could benefit one million people

In April 2011, the National Bariatric Surgery Registry (NBSR) reported the findings of the UK’s first large-scale study on the impact of weight loss surgery. The study of 1,421 operations found that not only did patients lose an average of 60% of their weight within 12 months of their surgery but the incidence of type 2 diabetes among these patients also fell by 50%. Following the findings of this report, the chairman of the NBSR said that bariatric surgery could benefit over a million people in the UK and that the treatment should be more widely available on the NHS.

The hope for those who undergo surgery, whether under the NHS or privately, is to achieve weight loss and a healthier life style. Not surprisingly, people tend to have high expectations of the outcome but, if the surgery does not go to plan, the consequences can be potentially devastating for the patient and their families. It is therefore vital that those carrying out the surgery ensure that all patients are appropriately advised on both the risks and benefits of the surgery.

Main risks and typical problems associated with weight loss surgery

The Medical Defence Union (MDU), which handles medical negligence claims brought by bariatric surgery patients against its members, indicates that the most common problems after this type of surgery include:

• post-operative complications such as infection, blood clots and internal bleeding
• gastric bands slipping or leaking
• delays in diagnosing these problems
• difficulties and complications in adjusting bands following surgery
• failure to obtain consent from patients or not consulting them about the risks involved.

The rapid weight loss associated with weight loss surgery can also cause a number of side effects such as: 

• excess skin
• gallstones
• psychosocial effects of surgery
• stomal stenosis (blockage of hole between stomach pouch and small intestine)
• food intolerance
• death

However, some are these problems are recognised complications of the procedure and do not represent negligent care. 

Negligent care

Issues which may be regarded as substandard or negligent care that result in claims include:

• Putting the band on the wrong part of the stomach or at the wrong angle during the gastric banding operation. This can result in complete blockage requiring emergency surgery. Failure to spot this situation developing post-operatively can often be negligent in itself.
• Failure to staple the joins properly in gastric bypass surgery can cause a leak and, again, a failure to recognise the development of a leak post-operatively can often be open to criticism.
• Performing the wrong type of bypass procedure.
• Surgeons who perform the procedure without sufficient expertise and making unacceptable technical errors.
• Quality issues with the gastric band itself which may result in a product liability claim against the manufacturer rather than the surgeon.

A further consideration is that this procedure is often carried out in private clinics by a surgeon with a full list of operations. This ‘conveyor belt’ approach can work well if the patient fully understands the procedure and there are no complications. However, the pressure of a full list of patients may mean that a surgeon cannot spend enough time consulting with the patient beforehand or deal with any post-surgery complications that arise.

At best, the patient may be disappointed by the outcome of their surgery but, at worst,  their clinical condition may deteriorate significantly in an environment that is not equipped to deal with emergency care, resulting in an emergency hospital transfer and, potentially, further surgery.

MDU risk management advice

Following a review of bariatric surgery cases against its members, the MDU has issued them with risk management advice to try to reduce the number of medical negligence claims. This advice includes ensuring that all patients are given information in a format they can understand about the recognised risks of the procedure, the post-operative diet required, and the weight loss to be expected.

It is important that anyone undergoing weight loss surgery is given enough information about what the surgery entails and any problems that may arise and that surgery is undertaken only by those who are medically qualified and experienced in this field. A high standard of post-operative care and a quick recognition of developing complications also appear to be key to a successful outcome.

We are currently dealing with claims for patients with a range of unexpected problems arising from gastric band surgery – ranging from a faulty band to incorrect insertion (and therefore function of the band) to suffering significant bleeding as a result of arterial damage during the procedure. All of these clients have suffered damaging problems and this evidences the importance of patients being properly advised and the procedure being done by a suitably experienced practitioner.

Penningtons Manches LLP has a specialist clinical negligence team that deals with clients nationwide. Within that team we have a specialist team dealing with cosmetic surgery claims for treatment performed in the UK and abroad. Members of the team can advise on issues arising from weight loss surgery and the options in relation to any claim.

For further information, click here and here.

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