What are the complications of metabolic surgery?

Question

Hello doctor,

My endocrinologist referred me for metabolic surgery evaluation but I am terrified of complications. I am 42 with a BMI of 48, uncontrolled diabetes for nine years (current A1C 9.8 despite Insulin 75 U daily and Metformin 2000 mg), hypertension (152/92 mm Hg on three medications), severe sleep apnea, and now early diabetic kidney disease with microalbuminuria, and eGFR 68. My father died from surgical complications so I am frightened. The bariatric surgeon mentioned sleeve gastrectomy or gastric bypass but did not explain the difference in terms of risks vs benefits for my specific conditions. Which surgery has the best outcomes for diabetes reversal? How dangerous is surgery for someone with my health problems? My latest laboratory tests showed potassium 5.7 and the surgeon mentioned this needs to be addressed before surgery. I have tried losing weight so many times but always gain back more. My mobility is getting worse from diabetic neuropathy and arthritis, making exercise nearly impossible. Please help.

Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concerns about metabolic surgery given your health conditions.

1. Diabetes reversal: Both sleeve gastrectomy and gastric bypass can significantly improve diabetes control. Gastric bypass generally has better outcomes for diabetes reversal due to its more profound effects on insulin sensitivity and glucose metabolism.

2. Surgery risks: Given your uncontrolled diabetes, hypertension, sleep apnea, and early diabetic kidney disease, surgery does carry higher risks. However, the benefits of improved diabetes control, weight loss, and resolution of comorbid conditions can outweigh these risks. It is crucial to have a thorough preoperative evaluation and address any issues like elevated potassium before surgery.

3. Potassium levels: Elevated potassium levels need to be managed before surgery to reduce the risk of complications. Your healthcare provider can guide you on how to lower potassium levels safely.

While surgery is risky, it can offer significant benefits for your overall health and diabetes management. Discuss these concerns with your bariatric surgeon and endocrinologist to make an informed decision. Please book a consultation with me if you would like more detailed information on any of these points or if you have other questions.

I hope this information will help you.

Thanks.