July 17, 2023 – Singer-songwriter Lisa Marie Presley died from a “strangulated,” or twisted, small bowel on Jan.12, shocking many followers who had seen her attend the Golden Globe awards ceremony simply days earlier than. The daughter of the late Elvis Presley was 54 years outdated.

The Los Angeles health worker dominated Presley died of pure causes and, in a report issued final week, linked her small bowel obstruction to bariatric surgical procedure she had years earlier. CNN, which first obtained the post-mortem, stated it included the official opinion of deputy health worker Juan M. Carrillo, MD, who stated the obstruction was brought on by “adhesions (or, scar tissue) that developed after bariatric surgical procedure years in the past. This can be a identified long-term complication of this kind of surgical procedure.” 

Surgical procedure specialists don’t dispute {that a} cutoff of blood provide to her small bowel, also called the small gut, led to her loss of life. However they’re much less sure that inside scarring from earlier weight reduction surgical procedure is responsible.

“It simply would not make precise sense to all of us [surgeons],” stated Marina Kurian, MD, president of the American Society for Metabolic and Bariatric Surgical procedure. “It feels like she had a bowel obstruction for positive. However it’s not clear to me … that it’s associated to the bariatric surgical procedure, as a result of these scars can be proper up by the liver and the abdomen, and the small gut will not be normally up there.”

Presley reported stomach ache earlier that day, in keeping with the health worker. It’s unclear if her ache had endured for days or come and gone in extreme bouts, that are frequent indicators of bowel obstruction. Vomiting and belly distention – when air or fluid gathers within the stomach and causes it to develop – are additionally frequent.

In lots of instances, bowel obstructions could be handled if medical care is sought early sufficient. “The message is clearly if in case you have belly ache, and it’s persistent belly ache, go see a doctor,” Kurian stated.

Not All Bariatric Procedures are the Similar

Bariatric surgical procedure consists of many various procedures, and Kurian thinks from the health worker’s report that Presley most certainly had a single anastomosis duodenal ileostomy (SADI). This sort of process lowers meals consumption by decreasing the abdomen dimension and limits absorption of meals by bypassing a part of the small gut.

A bowel obstruction can happen after many sorts of surgical procedure, not simply bariatric procedures. Gynecologic surgical procedure, urinary system surgical procedure, and normal belly surgical procedures can depart inside scarring that causes this complication, stated Kurian. “So it may very properly have been from another surgical procedure.”

If left untreated, bowel obstructions can minimize off blood provide, “which is sadly what occurred in Ms. Presley’s case,” stated Stacy Brethauer, MD, a bariatric surgeon and a professor within the Division of Normal and Gastrointestinal Surgical procedure at Ohio State College Wexner Medical Middle. 

Almost all bariatric procedures within the final twenty years have been carried out with minimally invasive strategies, like laparoscopy, that trigger much less scarring than open surgical procedure, Brethauer stated.

“Thankfully, bowel obstructions are fairly uncommon now after laparoscopic bariatric surgical procedure and happen in solely 1-2% of sufferers long-term,” he stated.  

Brief- and Lengthy-Time period Dangers

Total, the dangers of dangerous outcomes after weight reduction surgical procedure are “very, very low,” Kurian stated. Brief-term dangers embrace leaks, bleeding, an infection, and blood clots. Lengthy-term opposed results can embrace bowel obstruction and malnutrition. The danger of malnutrition from decrease absorption of vitamins could be lessened by sufferers taking multivitamins, for instance. 

For the overwhelming majority of sufferers searching for bariatric surgical procedure, the advantages far outweigh the dangers, each within the brief time period and long run, Brethauer stated.  Advantages embrace important discount in long-term deaths, most cancers threat, heart problems, and diabetes.

“Physicians ought to counsel sufferers that bariatric surgical procedure, like every surgical process, has some inherent dangers,” he added. Mortality charges are presently lower than 0.1% and main short- and long-term complication charges vary from 1% to 4%.

Dangers additionally range relying on particular person affected person elements and the kind of bariatric process, reminiscent of sleeve gastrectomy, Roux-en-Y gastric bypass, or the adjustable gastric band. 

Whether or not the affiliation with bariatric surgical procedure was behind Presley’s loss of life, “It’s so vital to stipulate how protected bariatric surgical procedure truly is. We get most individuals by means of surgical procedure ‘wholesome, hale and hearty,’” Kurian stated. 

Anti-Weight problems Drugs vs. Surgical procedure?

Requested if the rising reputation of anti-obesity drugs like Wegovy or off-label use of Ozempic will lower weight reduction surgical procedure, Kurian was uncertain. 

“Bariatric surgical procedure, truly, I feel won’t drop off,” she stated. “These medication are useful, however the ones that we presently have haven’t taken off as a lot weight as surgical procedure.”

Kurian believes surgical procedure affords a extra sturdy strategy to treating extreme weight problems. 

In the end, a choice on anti-obesity medicine and/or bariatric surgical procedure ought to be individualized and primarily based on a dialogue between a affected person and their physician. It additionally relies upon, partly, on how a lot weight an individual would wish to lose to be more healthy, Kurian stated. 

“These drugs are a incredible addition to our armamentarium for the remedy of weight problems,” Brethauer stated.  “These injectable drugs truly mimic the identical intestine hormone modifications we see after metabolic procedures like gastric bypass, sleeve gastrectomy, and duodenal swap.  

“Each bariatric surgical procedure and pharmacological brokers just like the GLP-1 receptor agonists are protected and efficient, and we use these drugs earlier than and after surgical procedure to advertise extra weight reduction and management starvation,” Brethauer added. The most important distinction between the 2 approaches is modifications from surgical procedure are extra everlasting in comparison with the drugs that require taking over an ongoing foundation. 

On the plus facet, extra persons are speaking about weight problems with the recognition of Wegovy, Ozempic, and different anti-obesity drugs. This might assist take away a few of stigma round weight problems, Kurian stated, and “it makes everybody notice that it is not nearly weight loss program and train.”

“It is great that persons are getting assist understanding … that it is not simply their failure however that there are physiologic and hormonal causes for the lack to drop some weight simply.”

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