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July 17, 2023 – Singer-songwriter Lisa Marie Presley died from a “strangulated,” or twisted, small bowel on Jan.12, sudden many enthusiasts who had observed her attend the Golden Globe awards rite simply days ahead of. The daughter of the past due Elvis Presley used to be 54 years previous.
The Los Angeles clinical examiner dominated Presley died of herbal reasons and, in a record issued final week, connected her small bowel obstruction to bariatric surgical procedure she had years previous. CNN, which first received the post-mortem, mentioned it integrated the authentic opinion of deputy clinical examiner Juan M. Carrillo, MD, who mentioned the obstruction used to be led to by way of “adhesions (or, scar tissue) that advanced after bariatric surgical procedure years in the past. This can be a recognized long-term complication of this sort of surgical procedure.”
Surgical treatment professionals don’t dispute {that a} cutoff of blood provide to her small bowel, sometimes called the small gut, resulted in her dying. However they’re much less sure that inner scarring from earlier weight reduction surgical procedure is responsible.
“It simply does not make actual sense to all people [surgeons],” mentioned Marina Kurian, MD, president of the American Society for Metabolic and Bariatric Surgical treatment. “It seems like she had a bowel obstruction needless to say. However it isn’t transparent to me … that it’s associated with the bariatric surgical procedure, as a result of the ones scars can be proper up by way of the liver and the tummy, and the small gut isn’t normally up there.”
Presley reported abdominal ache previous that day, in line with the clinical examiner. It’s unclear if her ache had persevered for days or come and long gone in critical bouts, which can be not unusual indicators of bowel obstruction. Vomiting and stomach distention – when air or fluid gathers within the abdominal and reasons it to extend – also are not unusual.
In lots of circumstances, bowel obstructions may also be handled if hospital treatment is sought early sufficient. “The message is clearly when you have stomach ache, and it’s chronic stomach ache, cross see a health care provider,” Kurian mentioned.
No longer All Bariatric Procedures are the Similar
Bariatric surgical procedure comprises many alternative procedures, and Kurian thinks from the clinical examiner’s record that Presley possibly had a unmarried anastomosis duodenal ileostomy (SADI). This type of process lowers meals consumption by way of lowering the tummy dimension and boundaries absorption of meals by way of bypassing a part of the small gut.
A bowel obstruction can happen after many sorts of surgical procedure, now not simply bariatric procedures. Gynecologic surgical procedure, urinary gadget surgical procedure, and normal stomach surgical procedures can go away inner scarring that reasons this complication, mentioned Kurian. “So it might really well had been from any other surgical procedure.”
If left untreated, bowel obstructions can bring to an end blood provide, “which is sadly what took place in Ms. Presley’s case,” mentioned Stacy Brethauer, MD, a bariatric surgeon and a professor within the Department of Basic and Gastrointestinal Surgical treatment at Ohio State College Wexner Scientific Heart.
Just about all bariatric procedures within the final twenty years had been carried out with minimally invasive tactics, like laparoscopy, that reason much less scarring than open surgical procedure, Brethauer mentioned.
“Thankfully, bowel obstructions are relatively uncommon now after laparoscopic bariatric surgical procedure and happen in simplest 1-2% of sufferers long-term,” he mentioned.
Quick- and Lengthy-Time period Dangers
General, the hazards of unhealthy results after weight reduction surgical procedure are “very, very low,” Kurian mentioned. Quick-term dangers come with leaks, bleeding, an infection, and blood clots. Lengthy-term adversarial results can come with bowel obstruction and malnutrition. The danger of malnutrition from decrease absorption of vitamins may also be lessened by way of sufferers taking multivitamins, for instance.
For nearly all of sufferers in search of bariatric surgical procedure, the advantages some distance outweigh the hazards, each within the brief time period and longer term, Brethauer mentioned. Advantages come with important aid in long-term deaths, most cancers possibility, heart problems, and diabetes.
“Physicians will have to recommend sufferers that bariatric surgical procedure, like every surgical process, has some inherent dangers,” he added. Mortality charges are recently not up to 0.1% and primary short- and long-term complication charges vary from 1% to 4%.
Dangers additionally range relying on person affected person elements and the kind of bariatric process, corresponding to sleeve gastrectomy, Roux-en-Y gastric bypass, or the adjustable gastric band.
Whether or not the affiliation with bariatric surgical procedure used to be at the back of Presley’s dying, “It’s so vital to stipulate how protected bariatric surgical procedure in truth is. We get most of the people via surgical procedure ‘wholesome, hale and hearty,’” Kurian mentioned.
Anti-Weight problems Drugs vs. Surgical treatment?
Requested if the rising approval for anti-obesity drugs like Wegovy or off-label use of Ozempic will lower weight reduction surgical procedure, Kurian used to be unsure.
“Bariatric surgical procedure, in truth, I believe is not going to drop off,” she mentioned. “Those medicine are useful, however the ones that we recently have have now not taken off as a lot weight as surgical procedure.”
Kurian believes surgical procedure provides a tougher way to treating critical weight problems.
In the end, a choice on anti-obesity drugs and/or bariatric surgical procedure will have to be individualized and in response to a dialogue between a affected person and their physician. It additionally is dependent, partially, on how a lot weight an individual would want to lose to be more fit, Kurian mentioned.
“Those drugs are an out of this world addition to our armamentarium for the remedy of weight problems,” Brethauer mentioned. “Those injectable drugs in truth mimic the similar intestine hormone adjustments we see after metabolic procedures like gastric bypass, sleeve gastrectomy, and duodenal transfer.
“Each bariatric surgical procedure and pharmacological brokers just like the GLP-1 receptor agonists are protected and efficient, and we use those drugs ahead of and after surgical procedure to advertise further weight reduction and keep an eye on starvation,” Brethauer added. The most important distinction between the 2 approaches is adjustments from surgical procedure are extra everlasting in comparison to the drugs that require taking up an ongoing foundation.
At the plus aspect, extra persons are speaking about weight problems with the recognition of Wegovy, Ozempic, and different anti-obesity drugs. This may assist take away a few of stigma round weight problems, Kurian mentioned, and “it makes everybody notice that it isn’t with reference to nutrition and workout.”
“It is superb that persons are getting assist working out … that it isn’t simply their failure however that there are physiologic and hormonal causes for the shortcoming to shed pounds simply.”
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