In my law practice as a Houston, Texas medical malpractice attorney, I have represented a number of patients who had severe complications from bariatric surgery.
The most common issues that I have seen in cases involve the patient’s inability to hold food and water down, accompanied by nausea and vomiting. Quite often, surgical experts that we have retained to review the cases have concluded that these issues were because of errors during the procedure in tightening the surgically-modified stomach too much.
One of the other significant problems that I have encountered involves repair of hiatal hernias. The hiatus is a small hole in the diaphragm through which the esophagus passes, to join the stomach. The physical location where the esophagus joins the stomach (the gastroesophageal junction) should be below the diaphragm.
In virtually every bariatric surgery case, there is also a separate hiatal hernia repair. Sometimes the hernias are significant and other times they are minor. Surgeons typically like to perform hiatal hernia repairs at the same time as bariatric or weight loss surgery because it allows them to bill the patient’s insurance company for an additional procedure that only takes a few minutes.
One of the surgical experts that our law firm has used to review cases specializes in complications of bariatric surgery. He explained that a surgeon repairing a hiatal hernia must first determine the location of the esophagus and stomach, in relation to the hiatus. The surgeon then must reduce, or pull down, any part of the stomach located above the diaphragm, and ensure that the gastroesophageal junction is also below the diaphragm. At that point, the surgeon does a few stitches at the hiatus to keep things in place.
If a hiatal hernia repair is stitched too tightly, it can cause problems that prevent the patient from being able to get food down, which, of course, results in nausea and vomiting. On other occasions, the surgeon does not properly visualize and reposition the stomach below the diaphragm before proceeding with the stitching. This can result in a terrible situation for the patient.
I recently successfully resolved a case for a patient who had a gastric sleeve surgery and hiatal hernia repair that left her with permanent excruciating pain, nausea, vomiting, and essentially an inability to eat.
In this patient’s case, our surgical expert concluded that the surgeon did not properly repair the hiatal hernia. In fact, radiology studies done in the two days following surgery showed that part of the stomach was above the diaphragm. For some reason, the surgeon waited a month before returning her to surgery, but by then the damage was too significant.
At that point, she was diagnosed with gastric volvulus, a condition involving the rotation or revolution of the stomach about an axis. To visualize it, think of a phone cord. The medical literature reflects the gastric volvulus can occur on its own or as a result of some other cause. One of those other causes is scarring or adhesions from prior surgery. In my client’s case that is exactly what happened. In the month after the unsuccessful surgery, scar tissue and adhesions formed that produced tension and stretching of the gastric ligaments, creating a situation where the stomach could twist.
The signs and symptoms of gastric volvulus include abdominal pain, vomiting, nausea, inability to hold food down (dysphagia), bloating, and sometimes chest pain. Unfortunately, these signs and symptoms are consistent with other illnesses as well, so a physician evaluating them must rule out various conditions. For bariatric surgeons, though, the diagnosis should be more straightforward.
Experts in treating gastric volvulus consider it a surgical emergency. The first step in treatment is to stabilize the patient with IV fluids, painkillers, and anti-nausea medications. In addition, intravenous (IV) fluids and inserting a nasogastric (NG) tube with suctioning are often used to help decompress and relieve pressure on the stomach. Once the patient is stabilized, surgery is necessary to de-rotate the stomach, including a procedure called gastropexy, which surgically fixes the stomach in place to prevent volvulus from happening again.
We are here to help
If you or someone you care for has been seriously injured as a result of surgical or medical malpractice, including bariatric or weight-loss procedures, call the experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, at 281-580-8800, for free consultation about your potential case.
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Robert Painter is a medical negligence attorney at Painter Law Firm PLLC, in Houston, Texas. He represents patients and their families in medical negligence and wrongful death lawsuits against hospitals, surgeons, anesthesiologists, and the doctors. A former hospital administrator, he was recognized by H Texas magazine and Houstonia magazine, in 2017, as one of Houston’s top lawyers.
