- The Washington Times - Thursday, August 12, 2004


An obese Massachusetts woman and her 8-month-old fetus died of complications 18 months after stomach-stapling surgery, an apparent first that is leading to warnings about the risks of pregnancy soon after the surgery.

The deaths raise concerns because most of the 110,000 people who have gastric, or stomach, bypass surgery each year in this country are women in their childbearing years, say doctors at Brigham and Women’s Hospital in Boston who tried to save the mother and baby. They reported on the case in a letter in today’s New England Journal of Medicine.

Brigham surgeon Dr. Edward E. Whang cared for the 41-year-old woman nearly two years ago, when she was brought to their emergency department after two days at another hospital, where the cause of sudden pain in her upper stomach was 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 a massive infection, Dr. Whang performed 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 show extremely obese patients have death rates as much as four or five times lower if they undergo gastric bypass surgery, compared with those who don’t, and other research shows lower rates of pregnancy complications after the weight-loss surgery.

Dr. Sugerman estimated more than 110,000 gastric bypasses will be performed in the United States this year. Complications strike as many as one in five patients, and it is believed that for every 200 patients, one to four will die.

In the standard type of gastric bypass surgery performed on this woman, 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, then is reattached to the lower segment.

Dr. Sugerman and other doctors said they know of no other mother-baby deaths after the operation.

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