Daily Mail highlights the risks associated with gastric balloon devices
Are surgeons hiding the deadly risks of obesity surgery?
- Obese Catherine De La Rosa, 54, from Leicester, weighed 23 stone
- Had a gastric balloon fitted but four days later she was dead
- Weight-loss device had perforated her stomach, allowing toxic fluids in
- Case is latest in series of fatalities and injuries following NHS surgery
Catherine De La Rosa was nervous about having weight-loss surgery, but having been assured by doctors that it was straightforward and safe, she decided to give it a try.
The 54-year-old grandmother was just 5ft tall but weighed 23st, giving her a body mass index (BMI) of 52, making her ‘super-obese’.
She had tried to lose weight with various diets but nothing worked long term. Her size restricted her movement and made her deeply depressed.
Doctors at Leicester Royal Infirmary were encouraging, however, explaining that inserting a gastric balloon would be the answer. The balloon would partly fill her stomach, making her feel fuller quicker, restricting her desire and ability to eat.
Catherine was convinced, says her son Keiron, that finally this might help her lead a normal, healthy life.
She had the surgery in June 2012. Four days later she was dead, having suffered traumatic blood poisoning.
At an inquest last September, a Leicester City coroner heard that the balloon had perforated her stomach, allowing toxic fluids to leak into her bloodstream.
Mrs De La Rosa’s case is the latest in a series of fatalities and injuries following NHS weight-loss surgery that have recently come to light. The toll includes two deaths following gastric bypass surgery in 2011 and 2012 at the Whittington Hospital, London, where a surgeon has been suspended pending the results of an investigation.
According to the NHS Information Centre, demand for weight-loss operations is rising rapidly. In 2006, there were 858 procedures, rising tenfold to 8,794 in 2011.
To be eligible for surgery on the NHS, people must have a BMI over 40, or a BMI between 35 and 40 but also suffer one or more obesity-related diseases, such as diabetes. Imperial College London estimated last year that as many as two million people in England are eligible for the surgery.
And NHS hospitals are gearing up to cope. For example, earlier this year the University Hospital of North Staffordshire announced plans to double the number of weight-loss operations and appointed a third obesity surgeon to keep pace with what it calls ‘the flood of morbidly-obese patients’ requiring surgery.
But there are concerns that patients aren’t being told the whole story about the risks of such surgery.
Furthermore, there is no precise record of how many problems have occurred with obesity operations, nor how many ‘revision’ surgical procedures are being performed to correct weight-loss operations that went wrong.
This is even though revision surgery is known to be the riskiest of all such ops because it involves the highly intricate task of repairing previous surgery.
She had a BMI of 52, making her ‘super-obese’, but hadn’t managed to lose weight with various diets
Kieron, 32, recalls how his mother became ‘frustrated and depressed’ that her attempts to lose weight failed. With her size at risk of damaging her health, doctors said surgery was the only way forward.
Catherine, who lived in Gibraltar, had the surgery performed in the UK under reciprocal health arrangements. ‘Before the op, we went to Leicester to speak to the doctors about it,’ says Kieron.
‘The surgeon said there would not be any problems so long as she kept trying to diet and thus kept her weight stable.’
Catherine’s daughter Stacey, 22, was with her mother at the hospital for the operation.
‘Afterwards, my sister rang to say that the doctors felt everything had gone well,’ says Kieron. ‘The next day, though, she rang again to say that Mum was complaining of pain and had begun to vomit – though the doctors had reassured her that this was a normal reaction.
‘I was worried. She was never one to complain, so if Mum was complaining about pain, then she’d really be in pain.’
The number of years since the first bariatric surgery was performed
The following day the vomiting got worse. The next morning the family was told she’d be sent for a scan – but she died later that day.
‘The doctors said something had gone wrong and that Mum had developed blood poisoning and had gone into cardiac arrest.’
Figures from the National Bariatric Surgery Registry suggest serious complications occur in only 2.6 per cent of cases. Three ‘post-operative in-hospital’ deaths occurred in Britain in 2013 as a result of weight-loss surgery, according to the registry, to which weight-loss surgeons submit their own results voluntarily.
But an authoritative British study in 2012 put the risks much higher. It found that one in ten of these operations results in significant problems, and that at least 29 deaths had occurred over a three-year period.
The inquiry by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found that one-third of patients had inadequate post-surgical care and monitoring.
Surgeons contributing to the National Bariatric Surgery Registry admit there is no good data to show how many ops have to be done again because the patient has become very ill. These revision operations carry the highest risk of death and long-term sickness.
Bertie Lee, who led the NCEPOD report and works as a malpractice lawyer, defending hospitals, warns: ‘I have seen too many cases of doctors being caught out by the significant surgical challenges posed by patients with obesity.’
Often, he says, the difficulties are worsened by ‘lack of thoughtful pre-operative assessment and the failure to do careful post-operative follow-up’.
Follow-up needs to be long-term. The report’s findings show that many deaths related to bariatric surgery can occur three or more years after the operation.
Two of the deaths following gastric surgery involved the Whittington Hospital, which is still conducting a long-running investigation involving the deaths of at least two women. In December 2012, it suspended a surgeon following the death of Jane White, a mother-of-three.
Mrs White, 39, from Romford, Essex, died following weight-loss surgery in September 2012. An inquest in June last year heard she died of ‘multiple organ dysfunction due to complications’, little over a week after her gastric bypass operation. Mrs White developed stomach pain, vomiting and diarrhoea two days after being discharged from hospital. A revision operation to discover and remedy the causes of her problems days later was ‘inadequately performed’, the coroner said.
In 2011, an inquest heard how Kim Blake, 33, a mother-of-one from North London, died from malnutrition caused by complications following gastric bypass surgery at the same hospital.
Ms Blake, who weighed 20st, had the initial operation in January 2010. It passed without complications but she could not keep any food down afterwards. Her weight plunged to 10st in ten months.
She died in December 2010, before an operation to reverse the procedure could be done.
So are these just exceptional cases? The fact is that many NHS hospitals are unprepared for dealing with weight-loss operations that go wrong.
Last January, researchers from King’s College Hospital, London, warned in the respected World Journal of Emergency Surgery: ‘Currently, there are no comprehensive guidelines for managing acute [emergency] cases of bariatric surgery.
‘The on-call general surgical and anaesthetic/critical care teams are increasingly facing such clinical scenarios with no standard plan of management.’
New guidelines are being put in place for ‘driving up standards’ on follow-up care and monitoring after weight-loss surgery, according to Richard Welbourn, the president of the weight-loss surgeons’ professional organisation, the British Obesity & Metabolic Surgery Society.
For Keiron De La Rosa, his mission continues to find out exactly what went wrong with his mother’s care. ‘I’m still struggling to come to terms with the fact that she is gone,’ he says. ‘I need answers about whether the hospital staff really did everything in their power to help Mum after the surgery.’
He has instructed solicitors Irwin Mitchell to press managers at the Leicester Royal Infirmary to give a full and open explanation of what went wrong.
John Jameson, the clinical director for surgery at Leicester’s hospitals, says changes have been made since her death.
‘Mrs De La Rosa suffered a rare but very serious complication of her surgery. We have carried out an investigation into her care and it found that staff failed to act quickly enough when she showed signs of deterioration.’
Clearly, much more needs to be done to create proper safety nets for people whose weight-loss surgery goes wrong.
As Tam Fry, a spokesman for the British Obesity Foundation, says: ‘There is a false allure in weight-loss surgery as an “easy” answer.
‘But weight-loss surgery is also a totally false economy when misused. People who imagine that it involves just a simple operation live in cloud cuckoo-land.’
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