Regardless of the procedure, if there's a significant risk of airway com-
promise — especially if the patient has sleep apnea — Dr. Cunneen
says it's best to have them monitored in a hospital.
Aftercare + adjustments
Also, give careful consideration to the aftercare required for certain
bariatric procedures, as follow-up appointments and adjustments will
have an impact on surgeon and room scheduling. Laparoscopic band-
ing in particular requires a good deal of aftercare, Dr. Cunneen says,
as patients have to come back for adjustments as many as 5 times the
first year and at least twice a year thereafter.
There's also the issue of post-operative support. If obesity is like
alcoholism, as some suggest, a patient's ability to keep off the weight
long term may hinge on the availability of ongoing peer support and
nutritional education, both in person and through social media.
"Patients are going to need to be educated about what to expect, as
S E P T E M B E R 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 1 1 3
The FDA says it doesn't yet know the root cause or incidence rate, and it
hasn't been able to attribute the deaths specifically to the devices or the
insertion procedures. The alert also cited 2 other balloon patients who died
from complications: a gastric perforation in 1 case; and an esophageal per-
foration in the other.
Still, researchers and physicians tout the safety and effectiveness of intra-
gastric balloons. A recent study (osmag.net/UkBmG8) shows that serious
adverse events occur in only 1.3% of gastric balloon cases, with a mortality
rate of 0.04%. By comparison, Roux-en-Y gastric bypass has a mortality
rate of 0.2% to 1%.
"It's not for everybody, but the band is still a good procedure that has a
place in bariatric surgery," says Scott A. Cunneen, MD, FACS, FASMBS, the
director of metabolic and bariatric surgery at Cedars-Sinai Medical Center in
Los Angeles, Calif. — Bill Donahue
