Smoking Increases Risk of Complications with Bariatric Surgery

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Obesity beats out smoking as the number one cause of preventable disease. The two combined make bariatric surgery riskier, particularly with respect to development of strictures and surgical-margin ulcers.

Adeshola Fakulujo, MD, of the Cleveland Clinic-Florida in Weston, presented the research at the 2010 American Society of Metabolic and Bariatric Surgery meeting.

Fakulujo and colleagues performed a retrospective cohort analysis and medical record review or 1,305 patients from 2004 to 2008. The patients had all sought consultations for weight-loss surgery. The analysis included patients who underwent gastric bypass, gastric banding, and sleeve gastrectomy. The prevalence and nature of complications were compared between smokers and nonsmokers.

The main complications of interest included marginal ulcerations, strictures, and fistula rather than other possible surgical complications like deep venous thrombosis and wound issues.

There were found to be 94 (7.2%) smokers among the patients who sought consultations. Of these, 72 underwent bariatric procedures. Of the 72, seven patients were lost to follow-up, leaving 65 smokers in the analysis.

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Of the smokers, 47 (73%) had Roux-en-Y gastric bypass, 12 (18%) had laparoscopic sleeve gastrectomy, and six (9%) had laparoscopic adjustable gastric banding. The overall complication rate in smokers was 18.4% (12/65). Interestingly, all of these patients had a Roux-en-Y gastric bypass. The complications consisted of 9 marginal ulcerations, 8 strictures, and 2 gastrogastric fistulae. Most of the strictures and both fistulae occurred in association with marginal ulceration.

Of the 959 nonsmokers who underwent bariatric procedures, 615 (64.1%) had Roux-en-Y gastric bypass, 114 (11.9%) had laparoscopic gastric banding, and 230 (24%) had laparoscopic sleeve gastrectomy. The overall complication rate was 5.6% (including associated complications), consisting of 35 strictures, 24 marginal ulcerations, and five gastrogastric fistulae

Smokers compared to nonsmokers had a three time increase in marginal ulceration (13.8% vs 3.9%) and an almost fourfold increase in strictures (12.3% vs 3.6%) and fistulae (3.8% vs 0.81%). Complications occurred later in smokers, an average of 14.3 months after surgery, compared with a range of one to three months reported in the literature.

Though not statistically significant (P>0.05), the frequency of marginal ulceration and stricture appears to be increased in smokers versus nonsmokers.

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Source reference:
Fakulujo A et al. "Prevalence and implicatiions of cigarette smoking in morbidly obese patients undergoing bariatric surgery." ASMBS 10. Abstract PL-114.

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