Patient bleeds to death after gastric band surgery

A mother told to lose weight to avoid serious health problems died hours after surgery to fit her with a gastric band.

Susan Alderson had three litres of blood in her abdomen and had bled to death, a post mortem found.

Experts had advised the 49-year-old to have the band fitted, a procedure which reduces the size of the stomach.

Susan Alderson received gastric band surgery at the former Derby City General Hospital in January. She later bled to death

But after the operation, which was also to repair a hernia, Mrs Alderson suffered internal bleeding, which claimed her life, an inquest was told.

Mrs Alderson, a diabetic who weighed more than 16 stone, was told by dieticians she would need the surgery to help prevent other potentially life-threatening illnesses.

She was admitted to the former Derby City General Hospital in January.

The hearing, attended by Mrs Alderson's husband and son, was told the operation went ahead without complications and Mrs Alderson appeared to be recovering well.

Derby Coroner's Court heard she started bleeding internally hours later, leading to a cardiac arrest and her death the next morning.

Paul Leeder, who carried out the operation, said: 'I had never experienced any problems with patients having severe complications. I had not had a death either before that operation or since.'

He said Mrs Alderson's body mass index (BMI), which determines whether a patient has a healthy body weight by measuring their height and weight, was 44, classing her as morbidly obese.

A patient who weighs too much in comparison to their height is in danger of developing problems such as strokes, heart problems, arthritis and an increased risk of cancer.

Mr Leeder said: 'Mrs Alderson had been on a low-calorie diet but had only lost four kilogrammes (nine pounds).

'The three options were for her to carry on as she was, without surgery, to have a gastric bypass or to have the gastric band.

'The risk of bleeding, risk of death and failure rate of the procedure were explained. But the long-term benefits of sustained weight loss would have far outweighed the risks involved with the surgery.'

After surgery, Mrs Alderson, of Sinfin, Derby, was moved into a recovery area, where her blood pressure started to drop.

Doctors gave her injections to help boost her blood pressure but, later that evening, it started to drop again. She was moved to a higher dependency ward and appeared to be recovering.

Mrs Alderson was later transferred to a 'step-down' ward, where she suffered a heart attack and later died.

Her post mortem examination found between two-and-a-half to three litres of blood collected in her abdominal wall, close to the repaired hernia.

Dr Andrew Hitchcock, consultant pathologist at Royal Derby Hospital, said it was not clear where the bleeding had originated.

Dr Hitchcock said Mrs Alderson's medical cause of death was internal bleeding, related to the hernia repair and gastric band operation.

Recording a narrative verdict, deputy coroner Louise Pinder gave the cause of death as intra-abdominal haemorrhage and incisional repair and gastric band application.

Miss Pinder said: 'She had no particular interest in losing weight for interests of vanity, this was very much a medically-based decision.'

A spokesman for Derby Hospitals, said: 'Our thoughts are with Mrs Alderson's family.

'Any surgery carries a risk and in Mrs Alderson's case the risks were higher due to her high BMI, severe diabetes, liver problems and a hernia repair.

'These factors meant that when Mrs Alderson developed complications, her blood did not clot in the normal way.

'The coroner said that the clinical team could not have foreseen the tragic outcome in Mrs Alderson's case.'

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Hospital criticized over death of 420-pound woman after gastric bypass surgery

Manchester, UK

A 420 pound woman who had a gastric bypass operation died at a hospital where staff hadn't been properly trained to care for obese patients.

Janice Barnardo, 46, was the first patient to undergo the weight-loss surgery at Tameside Hospital and was taken back in to repair problems with the surgery five days later.

A Stockport inquest heard staff were not trained to operate adapted beds for patients recovering from the surgery.

Miss Barnardo's bed - specially designed to provide support for overweight patients - had been left unplugged for two days. It was called a bariatric bed after the branch of medicine that deals with obesity.

Sections of the beds can be raised and lowered automatically to keep patients comfortable and prevent bed sores. Pathologist Andrew Yates said the cause of death was heart failure, gross obesity, high blood pressure, diabetes, asthma and pressure sores.

Jane Doyle, surgical ward manager, said staff had not been trained to operate bariatric beds. She said: "The hospital's bariatric policy was in draft form and had not been finalised."

Elaine Hughes said when her sister, Miss Barnardo, was put on a ward after leaving intensive care she felt unhappy.

Mrs Hughes said: "When she came back from the intensive care unit at Tameside, Janice was put in a bed at an angle at the end of a long ward.

"The first thing you saw coming on to the ward was Janice in a huge bed. She felt like she was in a freak show.

"We asked that she be moved to a side ward. That was so cramped we could not get around the bed." Miss Barnardo, from Mossley, had the operation in February 2007 and required surgery to repair a leak five days later. By the end of the following month, surgeon Abduljalil Benhamida discharged her to Shire Hill, Glossop, for rehabilitation.

But Miss Barnardo later developed deep bed sores and in May 2007 she returned to Tameside with septicaemia and later died.

Coroner John Pollard recorded a verdict of misadventure. He criticised nursing notes and said he would write to the chief executives of the local NHS trusts highlighting his concerns. After the inquest, Mrs Hughes said: "Janice's problems started on ward 15 at Tameside Hospital. Staff were not trained to care for bariatric patients."

A spokeswoman for Tameside Hospital Trust said: "This case highlights the complex medical and psychological rehabilitation needs of patients undergoing surgery of this nature and the need for careful assessment, planning and co-ordination of services to minimise the risk of similar problems in the future."

Jill Pinington, of Tameside and Glossop primary care trust, said: "Since Miss Barnardo's death an audit has shown a significant improvement in standards of documentation and note-keeping."

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Family demand answers after gastric bypass death

Macclesfield, UK

The family of a woman who died following a gastric bypass are demanding answers into her death.

Suzanne Wrighton, aged 59, died on May 30, 2008, less than 36 hours after having three operations at The Regency Hospital in Macclesfield.

Mrs Wrighton, who lived in Moreton Road, Crewe, decided to go in for the surgery paid for by the NHS at the private hospital because she was overweight and suffered from back pain.

Her husband Brian, aged 64, yesterday told an inquest into her death at Macclesfield Town Hall that he and his wife had been to two consultations prior to the operation and had been told there was a one per cent chance of fatality.

He said: "Suzanne had suffered from back pain for a long time. It started after she had a car crash in 1987. She had two operations on her spine but she still suffered from pain and she put on weight because she couldn't exercise.

"She decided on a bypass rather than a band. We know there is a risk with any operation but the risks we were told about weren't enough to worry her."

The inquest heard that after the first operation on May 28 Mrs Wrighton was in severe pain.

The following day consultant surgeon William Brough decided to perform a second operation to find out what the problem was but it wasn't until May 30 after the third operation that he found Mrs Wrighton had suffered a bleed.

Mr Brough said: "This was a rare complication that could not have been seen beforehand.

"It is the first time I have heard of a bleed from the staple line."

Mr Brough said that since Mrs Wrighton's death the hospital has altered protocol to ensure that all patients no matter how ill they are will have blood tests the day after the operation.

Mrs Wrighton died from adult respiratory distress syndrome (ARDS), which is when the lungs become filled with fluid and can't function properly.

Deputy coroner for Cheshire Janet Napier recorded a verdict of death due to complications following an operation for weight loss.

After the inquest Mr Wrighton, said: "We will be speaking to our solicitor and launching a complaint against the hospital. We are not happy with how Suzanne was treated. She was screaming out in pain most of the time she was in the hospital."

Suzanne's daughter-in-law Tammy Buxton, from Burslem, said: "The inquest hasn't really answered our questions.

"We still don't know why they failed to find the bleed until after the third operation.

"We have got to the bottom of the reason why she died. We don't want other families to go through the same pain and trauma we've been through."

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Another Complication For Gastric Bypass Patients

November 27, 2007

Obese patients who suffer complications after gastric bypass surgery may face further health risks because their weight exceeds the limits of diagnostic imaging equipment, according to a study presented November 27 at the annual meeting of the Radiological Society of North America. In the study, approximately 27 percent of patients weighing more than 450 pounds needed imaging to diagnose a problem after surgery and could not be accommodated because of their size.

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"When patients weigh more than 450 pounds, standard diagnostic imaging often cannot be used," said Raul N. Uppot, M.D., an assistant radiologist at Massachusetts General Hospital (MGH) and instructor of radiology at Harvard Medical School in Boston. "In these cases, physicians must resort to other means of diagnosis such as exploratory surgery or using less accurate or more invasive techniques."

According to the Centers for Disease Control and Prevention, obesity has grown dramatically in the last 20 years. Today, nearly one-third of the American population is obese. Along with the rise in obesity among American adults has come an increase in the number of gastric bypass procedures performed.

The American Society for Bariatric Surgery estimated approximately 140,000 gastric bypass procedures were performed in the United States in 2005. In a gastric bypass procedure, the stomach is surgically reduced, and part of the small intestine is bypassed. Like any surgical procedure, gastric bypass is not without risks. Most common complications include suture tears and leaks, pulmonary embolism, pneumonia and infection. Serious complications tend to be more prevalent among the severely overweight.

Dr. Uppot and colleagues conducted an eight-year retrospective study of all patients weighing more than 450 pounds who underwent a gastric bypass procedure at MGH between June 1999 and April 2007. Patient imaging usage and clinical course were tracked using electronic health records and evaluated to determine the outcomes of those who, based on their weight, were denied their physicians' first choice of imaging. The maximum weight limit for a computed tomography (CT) table is 450 pounds.

The researchers found that 12 (27 percent) of the 44 patients who weighed more than 450 pounds required postsurgical imaging because of a clinical condition, but were denied because they were above the weight restriction for the equipment. Four patients who could not be evaluated with imaging for suspected leaks were required to return for surgery.

Two additional patients with suspected lung blood clots could not undergo a chest CT. Of two patients who came in with nonspecific abdominal pain, one was evaluated with ultrasound and the other one had a barium swallow test. Because imaging was not an option, one patient who suffered trauma underwent exploratory surgery in lieu of noninvasive imaging. Another patient was denied a chest CT and received no further imaging evaluation.

"When obese patients cannot be diagnosed using standard-of-care imaging techniques, then other diagnostic measures have to be instituted," Dr. Uppot said. "Patient care may be ultimately affected due to a compromised diagnosis."

Dr. Uppot noted that the obesity trend cannot be ignored. "Unless major changes are made to the American diet or exercise habits, this is a problem that we will have to address," he said. "When an obese person is contemplating gastric bypass surgery, he or she should consider that they will need follow-up imaging but may not be able to get the appropriate tests."

Co-authors of the paper presented by Dr. Uppot are D.V. Sahani, M.D., D.A. Gervais, M.D., P.R. Mueller, M.D., P.F. Hahn, M.D., Ph.D., and S.I. Lee, M.D., Ph.D.

Adapted from materials provided by Radiological Society of North America.

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Death Rate Higher after Gastric Bypass Surgery

Death Rate Higher after Gastric Bypass Surgery

PITTSBURGH, Oct. 16 (UPI) -- A Univershttp://www.blogger.com/img/gl.link.gifity of Pittsburgh study found 6 percent of those undergoing bariatric surgery -- a treatment for severe obesity -- died within five years.

The study, published in the Archives of Surgery, also found the death rate for those with the surgery higher than that of the general population in the cases of heart disease and suicide.

Dr. Bennet I. Omalu, of the University of Pittsburgh, and colleagues analyzed data on all bariatric operations performed on Pennsylvania residents between 1995 and 2004. Following 16,683 operations, 440 patients -- less than 3 percent -- died. Almost 20 percent of those deaths were from heart disease.

The study authors suggest mortality after bariatric surgery could be reduced by better coordination of follow-up after the surgery, especially control of high risk factors such as hypertension, diabetes, high cholesterol and smoking.

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Mother of 6 Dies Days after Gastric Bypass Surgery

(London, UK)

A dedicated mum-of-six who was desperate to lose weight died just days after a gastric bypass operation.

Annette High, 42, had already lost seven stones after having a gastric band fitted in 2000. But as her weight crept up from 14 stone she decided she needed more drastic action. Despite her family's pleas, Annette decided to have the NHS funded operation, which reduced her stomach and removed part of her bowel.

She was found collapsed by her husband Gavin just four days later at their home in Hull, East Yorks. She died in hospital on May 12th and a post mortem revealed she had a previously undetected heart defect. She died as a result of heart disease.

Speaking after the inquest on Wednesday at Hull Coroners Court, Gavin said: "I begged her not to have it. I loved her whatever she was like. It didn't matter about her weight. More >>

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