Smoking and Gastric Bypass Surgery

Question

My doctor said point blank that he doesn't operate on smokers but he doesn't care if you start smoking again after surgery. Why? What are the surgical risks?

Babak Moeinolmolki, MD, FACS · Answer

Hello,
Thank you for your question. Your surgeon is in good company and clearly has your best interest in mind. 
Smoking increases your chances of having life-threatening complications after the surgery, such as a leak in the new connection from your stomach to your intestines and blood clots (deep venous thrombosis) that can travel to your brain or hears resulting in stroke or heart attack. Months after surgery, smoking increases your chances of suffering an ulcer that can cause significant pain and even life-threatening bleeding.
Of course, these risks are on top of the increased risk of heart attack, stroke, and cancer in ALL people who smoke.
Quitting smoking will serve you well both before and after the surgery. Ask your surgeon to connect you with smoking cessation resources in your area.
Best wishes,
Dr. Moein

Ariel Ortiz, MD, FACS · Answer

We are   very strict  about smoking before surgery,  plain and simple smoking has been shown to  increase the incidence of pulmonary  complications,  postoperative infection rate, cardiovascular complications, healing time, just to name a few. We ask our patients to stop smoking at least one month  before surgery in addition to quitting long term.  The surgery should be part of your path to wellness, if you are start smoking again, you are sabotaging those efforts.

Cesare Peraglie, MD · Answer

Hello,
Lets start with smoking AFTER surgery. There is no Doctor that I know of that would be OK with you smoking (either before or after surgery). This is whether or not you have had Bariatric Surgery.
Before Surgery: Increasd leak rate, pulomonary complications, poor wound healing, blood clots.
After surgery (If bypass): Increase risk for marginal ulcers (Very Bad), gastritis, pulmonary complications and above listed issues.
In general: All of the bad things that we already know about smoking.

H. Joseph Naim, MD, FACS · Answer

Unfortunately some patients are not truthful to their surgeon.
This will only effect them in a negative way. Smoking not only will cause LUNG CANCER and HEART DISEASE, it will also increases the chance of major complications after any elective surgery. 
Cosmetic surgeons and Weight Loss surgeons, in particular, will not advise surgery on anyone that smokes. The more you smoke, the higher risk of complication like staple line leak, and ulceration.
Most physicians don't check with any blood, or urine test for nicotine level, and trust their patients. This trust should be on both sides between the patient and surgeon.

Lloyd Stegemann, MD, FASMBS · Answer

I sort of agree with your surgeon.  I also don't operate on anybody who is an active smoker, but I STRONGLY urge patients not to start smoking again once they have had their surgery.  Unfortunately I have a lot less control of a patient's smoking behavior after surgery.  Here are some of the reasons why I don't operate on smokers:

	1)  Smoking increases the likelihood of the two biggest killers of weight loss surgery patients in the early post-operative period:  leaks and blood clots.  By getting someone to stop smoking at least 6-8 weeks before surgery it likely makes it safer for them to undergo the surgery on many different levels.

	2)  If someone can't stop smoking before surgery, why would I think that they would be committed to make the OTHER very difficult and challenging lifestyle changes (dietary, behavioral, and exercise) that are needed after surgery to create long-term success?

	3)  Patients that start smoking after their gastric bypass often will get ulcers at the connection of their pouch and small intestine (gastrojejunal ulcer).  These ulcers can be VERY difficult to treat and I personally have had to do two gastric bypass reversals because the patients developed ulcers that would not go away and they refused to stop smoking. 

	4)  I went into medicine to make people healthier.  If I can use my "power" before surgery to help (some would say force :) ) someone to stop smoking, which we KNOW will improve their health, I would be remiss if I didn't use that opportunity.  In my experience, although some patients will start smoking again after surgery, many will not.

	Stopping smoking is hard.  Really hard.  But smoking and weight loss surgery really don't mix well and the results of smoking, unfortunately can be disasterous.

Ricardo M. Bonnor, MD, FACS · Answer

I choose not operate on patients that smoke and choose to have a gastric bypass. Clearly the complication rate which includes leaks after gastric bypass is higher with smoker than non-smokers. The healing is compromised in patients that smoke. Also patients that smoke after surgery have a higher complication rate as well such as ulcers developing in the anastomosis and these ulcers can bleed or ultimately perforate.

Shawn Garber, MD, FACS, FASMBS · Answer

I do not operate on smokers. This is for many reasons. Smokers do not heal well and have a higher risks of leaks and developing ulcers. Also if we are going to perform a surgery to increase your lifespan by 12 - 15 years, what is the purpose if you just die from lung cancer?

David Buchin, MD · Answer

The reason that bariatric surgeons will not operate on smokers is because complications are significantly increased due to smoking. The risk of a leak from the connection that we make is much higher because smokers do not heal properly.   Also your risk of Deep Venous Thrombosis increases significantly as well. Bariatric surgeons make their patients quit smoking at least eight weeks prior to surgery because this improves healing.

	I'm sure that your bariatric surgeon does care that you have started smoking once again. You have done this procedure to improve your over all health.  Smoking is the number one preventable cause of death in the United States. So why start smoking now?

	There are plenty of risks associated with smoking after gastric bypass surgery. Smokers are at a much higher risk of gastric pouch ulcers which can cause significant pain in the upper abdomen. Smoking can also cause bleeding ulcers and perforated ulcers which can be life-threatening. If you have restarted smoking my suggestion would be to quit as soon as possible.

Smoking and Gastric Bypass Surgery

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