Lap Band Surgery + Alternatives: The Risks + Benefits

Posted on April 7, 2011 by Julian Johnson

Working yesterday and today on a very tragic case for the family of a young women who died after weight-loss surgery, in 2007.

The women underwent a sleeve gastrectomy, one of the 2 most common forms of weight-loss (or bariatric) surgery, performed in Australia today.

While working on the case, I thought it worth sharing the advice we have recieved in recent cases, as to both the success + the risks associated with these 2 most common forms of surgery. Don't hesitate to contact me if you disagree with these figures, which are taken from expert advice from a very experienced bariatric surgeon we have asked to consider such cases:

LAP BAND SURGERY
This is the most common procedure. Completed over 11,000 times in Australia per annum.

average effectiveness: 50% of the excess weight carried by the patient (on average patients lose 1/2 the weight they wish to). Effectiveness does vary significantly.

risks: 0.1 - 0.5% of major complication risk. So 1 in every 200 patients to 1 in every 1,000 patients will experience this. From simple maths, each year, 11 - 55 patients will suffer such major complications in Australia from this procedure. 1 in 2,000 risk of death: so 5 - 6 patients per year will die from lap band surgery.

SLEEVE GASTRECTOMY
average effectiveness: 70% of the excess weight carried by the patient (on average, patients lose 70% of the weight they wish to: this is obviously an advantage of such surgery over lap banding).

risks: 2 - 5% major complication risk. Risk of major complication therefore up to 50 times higher than with lap band. Most common major complication, as in our case, is anastomotic leak (leak from the staple line where the 'new' stomach edge is sewn up). Mortality rate is 1 in 500-600. So about 4 times higher chance of death.

Comment

Interesting features of this are, in my view:

  • the fact such surgery, if successful, should be accepted as only assisting with weight loss. It will not on its own be a 'quick fix' to obesity issues. With lap bands, the morbidly obese will remain obese even if such surgery is effective.
  • the lap band is safer but less effective than a sleeve gastrectomy.
  • patients undergoing such surgery need to appreciate and be comfortable with taking the risks, including a clear risk of death associated with such surgery. This should be particularly borne in mind, when such bariatric surgery is for cosmetic reasons, rather than genuinely medically driven. For someone to undergo such surgery, with the aim of becoming 'thinner,' and then lose their life through such process is tragic, and yet from the above such risk is clear + should be recognised and considered by the patient, before they agree to proceed.

 

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Surgery-Tourism - the Pitfalls?

Posted on July 2, 2009 by Julian Johnson

We are presently acting for a young women who paid $1,000s for cosmetic breast surgery in a well known Asian holiday destination, only for a terrible outcome.

This idea of "cosmetic surgery-tourism" seems on the increase, which I think is worrying.  My concerns are reinforced given the independent plastic surgeon's advice we have now received concerning the standard of advice and surgery our client received in this case.

Not that I am an expert, but anyone contemplating this sort of combination of a holiday and cosmetic surgery, should seek a local surgeon's advice.  Based on this case, it is not a comparison between apples and apples (unless one of them is rotten!) and any potential costs savings need to be carefully considered !

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Why Early Settlement Still Remains a Good Idea (only)

Posted on June 17, 2009 by Julian Johnson

Musing on a claim that I settled a week or so ago. The matter was settled within 45 minutes, via pre-trial settlement discussions at Court supervised mediation.  The claim concerned complications following a hysterectomy.

The allegations of negligence related to the gynaecologist's failure to discuss alternatives to hysterectomy for control of our client's pre-menopausal heavy periods.  

In the last couple of years, this has been our most common type of claim - hysterectomy remains a medical procedure with a relatively high frequency of serious complication.  These days there are a whole range of conservative alternatives to seek to treat heavy bleeding type symptoms for women. 

The settlement was a good result for the client in what was an indefensible case.
 
I was reflecting however on how we had written to the relevant medical insurer 12 months ago, before any court proceedings were commenced, suggesting early settlement discussion, because of the claim's relatively modest size (<$50,000 - thankfully our client made a good recovery after a fairly torrid initial post-surgery period) and the strength of the negligence allegations.
 
I can say with certainty that if such approach had been pursued by the insurer, the claim could have been resolved on precisely the terms negotiated this week, at that time.
 
The benefits of this are clear. A saving of legal costs for both sides (ultimately largely borne by the insurer), saving of Court resources on the dispute and the therapeutic advantages for my client of any earlier resolution, without the fight.
 

This is clearly a problem being grappled with internationally.

 

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IPL - the Dangers

Posted on June 14, 2009 by Julian Johnson

 We have for some time been investigating a potential claim for a young women in her 20s with a fair complexion who underwent IPL for freckles on her face, including eyelids. Our client suffered quite severe iris damage as a consequence of the treatment.  It seems the IPL damaged the pigment in her iris, leading to an asymmetrical appearance.

We have now received our expert's report. This has confirmed the inappropriateness of such treatment to this area, the danger of the sort of complication our client experienced and the need for titanium (or other effective) eye protectors for any IPL treatment in proximity to the eyes (our client was given paper 'protectors').
 
This case raises concern quite apart from for our poor client who is left permanently disfigured. As with many such cases, the treatment was provided by a beautician, and at present we have no idea as to her training/qualifications (other than suspicions from the way the treatment was performed).
 
This seems clearly another area of 'cosmetic' medicine, crying out for better regulation.
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