Are leaks a sign of an incompetent surgeon?

The answer is obvious if a surgeon has MANY patients that have had leaks or if a patient goes home right after surgery, eats popcorn and bursts (as I read here). My question is about those surgeons that "only" have a few.

Is our goal to find a surgeon that has 0 leaks?

I think it would be nice but any doc can have 0 leaks until he does the next surgery. I read that that percentage overall is less thatn 1% of all surgeries in the U.S. so I think it is a pretty low risk no matter who the surgeon is. That said I did ask my surgeon if he had, had any patients leak and what the cause was before I had mine done.

Well, I personally looked for a physician that had well below the national average and I think that is what you should definitely aim for. That and looking at their mortality rate. I hope I can live through a leak, but a death.... that is forever.

When I get home, I will get you the statistics for my surgeon, Dr. Webb at North Florida Surgeons. His last leak was over two years ago and the person who it happened to.... well, he drank a big gulp a couple weeks after surgery. I don't think I can blame Dr. Webb for that one, lol. And he has no deaths on his record.

How do you check for deaths on your doctor?

How do you check for deaths on your doctor? I mean beside just asking?

Ate popcorn and BURST!!!??? Is that possible?? To BURST our new tummies???? Oh my gawd.......how horrible......

And yes, how do you check for deaths...must be public knowledge/stats somewhere?

I am not sure if they list mortality rates but this site does let you see reviews from other patients http://www.ratemds.com/

Leaks are funny little things. Most agree that they occur during surgery, and aren't initially found due to swelling from the traumatic surgery. That's why you see leaks found between 2-30 days out on average. I've read of 2 stories on OH where ladies had leaks that went months undiagnosed and they were treated for other conditions, kidney infections, and other things and the leak just wasn't caught. One lady was a textbook surgery, followed her program to the T, didn't eat foods not allowed, the other lady was eating mashed peas and pureed chicken within the first week because she was just too hungry. Neither of their surgeons would say what caused the leak, or that anyone was at fault. The leak stat for an experienced surgeon should be 1% of less. My surgeon had zero leaks, and I ended up with a leak. He is experienced in band to RNY revision, and had around 200 sleeves under his belt, he had done some band to VSG revisions, and I was confident in his skill. I was also a tough revision with severe damage to my stomach tissue so my risk for a leak was quadrupled due to the band. I knew I'd be at a higher risk for complications. My leak was detected 2 days post-revision. I was feeling amazing, no fever, and it was detected on my last leak test about 2 hours before I was to be discharged. I had been up walking, feeling good, laughing with the nurses, but the second I swallowed the gastrographin Fluid, it hit my stomach, I knew I had a leak. I was rushed back into surgery for them to repair it. I had not eaten anything, and had drank very little as I was still on an IV for fluids.

Leaks are related to healing and surgical technique. Within the first 2 weeks, the staple line is healing, but if there is a pinhole leak present and it goes undiagnosed, it will grow as the swelling decreases.

Great responses. Thank you!

It's important to remember that medicine is a game of odds; there is ALWAYS a chance of a bad reaction or bad surgical outcome, even with the best doctors. When a doctor has a complication rate at or below the median rate for that procedure, it shouldn't be seen as a negative for the doctor; nor should a zero complications rate be seen as a positive. Complications are due to individual physiology -- e.g. my body may be more aggressive with infection and inflammation than yours, and yours may be better at building fibrous scar tissue quickly; how could the doctor know that before hand? -- and pure old random chance.

So I'd say that your task in picking a surgeon is to look for one whose complication rate isn't ABOVE the median rate. Beyond that, I would just not worry too much, since it's all a game of chance as long as you're following the post-op instructions carefully.

Patient non-compliance is by FAR the biggest cause of post-surgical complications, BTW. That should tell you something right there...

So I'd say that your task in picking a surgeon is to look for one whose complication rate isn't ABOVE the median rate.

How do we find this out? Aside from asking the surgeon.

Also, a large study of bariatric surgeries showed that the more surgeries the surgeon had under his/her belt, the lower his/her rate of complications.

What are the symptoms of a leak?

I experienced a leak one week post-op. Everything was going along normally. Then I took a sip of something, and was hit with an excruciating pain that went from my lower left abdomen all the way up to the top of my left shoulder. I waited for it to subside, but it just got worse. Needless to say, I was back in the hospital that day. I don't know if this is typical.

Can I say a big factor being ignored here is comorbidities and their effect on post-op healing????

The majority of us (I won't say all - I am constantly amazed with the stories of folks getting bariatric surgery with less than BMI of 30 and no weight-related diseases...but that's the nurse in me talking ), had this surgery because we were either A) Very seriously obese, Had very serious weight-related diseases (diabetes, sleep apnea, degenerative bone changes, etc), or C) All of the above.

It's a dirty thing that us fluffy folks don't like to talk about, but simply being overweight (let alone obese...or beyond) compromises our body's natural healing process in relation to surgery - especially the major invasive kinds. We become slower to heal, have higher infection rates, and significantly higher rates of things like dehissance, necrosis of tissue along surgical lines, leaks along surgical lines and generalized surgical complications. Let's then add further to that with the influence of the before-mentioned comorbidities: Diabetes slows wound healing and increases the risk of post-op complications. Sleep Apnea: ditto. I could go more into the "how" and "why"...but I don't want to go into a 3-page ramble

So even with the PERFECT surgeon, the PERFECT surgical technique, the PERFECT nursing care, PERFECT patient post-op compliance....we are at higher risk for issues, simply put....because we are sick and fat. Which is why we invested in this life-saving procedure in the first place, right?

I don't want anyone to think I am trying to deter people from surgery - far from it. I just believe that everyone should be well-educated before going under the knife.

The point about obesity-related comorbidities is very good! Very fat people tend to be very sick -- fat-acceptance aside, obesity is really a disease state, on so many levels.

That being said, here are the biggest "real" risks of the sleeve:

1. Patient non-compliance. The doctor said only slushy food until 3 weeks out, but you knew that didn't matter; your cousin had the sleeve and she was eating a whole pizza at 3 weeks, so you know better than your stuffy old doctor. Next stop: the emergency room!
   
2. Facilities! I hate to say it, but you are at more risk from the cleaning staff than the surgical staff; if you get a hospital-acquired infection, you're in trouble. And even if there ARE complications during surgery, it's more likely to be anesthesia-related than surgery-related.
   
3. Plain old bad luck: you're one of those higher risk patients, or you just have a common anatomic abnormality. It's a roll of the dice -- sure, a doctor with more sleeves performed will see more of the common abnormalities, but nobody's seen and dealt with them all.
   

You just can't protect against those three, and they are by far the greatest risks to you during and immediately following your sleeve surgery.