Make us your home page

Today’s top headlines delivered to you daily.

(View our Privacy Policy)

Extreme obesity adds extra level of danger to surgery

At 650 pounds, Michael "Big Mike" Barbetta feared he wouldn't live to see his 40th birthday. After more conservative weight loss measures failed, the 31-year-old St. Petersburg lawyer hoped the lap band surgical procedure to limit his stomach's capacity would be the answer.

But shortly after the surgery, he developed an infection, friends said. He died Oct. 11 before leaving Palms of Pasadena Hospital.

His surgeon did not return calls for comment. But doctors who treat obese patients (although not Barbetta) say his end is a sad reminder of the risks that extremely obese patients face when undergoing any kind of surgical procedure.

"Everything you do in these patients is different and more difficult," said Dr. Alexander Rosemurgy, who performed more than 1,000 weight loss surgeries in 10 years at Tampa General Hospital.

"People who are heavy have a whole different set of potential problems," compared to normal-weight patients, he said.

While any surgery carries risk, the danger increases substantially in the obese, particularly those who are more than 100 pounds above ideal weight.

"Morbid obesity triples the risk of dying from any procedure," said Dr. Dany Sayad, a cardiologist with the Florida Cardiovascular Institute Heart Center in Tampa.

"I have a lot of patients who need a catheterization (to open blocked vessels) or a pacemaker or defibrillator," said Sayad, "I tell them to lose at least 20 pounds before surgery because of all the risks."

The chief risk is — as in Barbetta's case — infection. "It's harder for fatty tissue to heal because it doesn't have the same blood supply," said Rosemurgy. With blood circulation impaired, the immune system can't fight off infection as well, giving bacteria a better chance to invade.

Extremely heavy people are also more likely to develop blood clots that can cause heart attacks and strokes. One reason: It's hard for them to get out of bed and get moving soon after surgery, which is recommended to prevent clots.

Another hazard: Medications are metabolized differently in the obese. Certain drugs linger in fat, meaning their effects can last longer. Other drugs need to be increased as body weight rises. Finding the right dose can be tricky, particularly with anesthesia and medications for pain.

"They may wake up from surgery much more slowly because the drug is released from the fatty tissue for a longer period of time," said Rosemurgy. "As a surgeon, you walk a tightrope with medications and must monitor these patients closely for a long time."

Additional flesh can make it more difficult to insert a breathing tube. Further, obese patients are more likely to aspirate stomach fluid into their lungs, which can lead to pneumonia.

Put all of these issues together, and even simple problems can snowball, Sayad said. "That's why some surgeons don't like to take big patients. These patients can quickly spiral down."

When possible, doctors like Sayad insist on pre-procedure weight loss both due to the risks, and also so patients will get some benefit from the surgery.

"Patients going for back surgery or hip surgery, if they don't lose weight, it doesn't matter what you do for them, they will break their hip again or re-injure their back,'' Sayad said.

Sometimes even a small loss, say 20 to 25 pounds, can make a big difference because it can improve diabetes, high blood pressure and sleep apnea, which can complicate recovery.

Although Rosemurgy now specializes in pancreatic cancer surgery, many colleagues send him their obese patients, because of his background in bariatic surgery. He understands the reluctance of some doctors to do this work.

"It really is hard,'' he said. "It takes experience working with heavy people before you have a comfort level.''

Irene Maher can be reached at [email protected]

Extreme obesity adds extra level of danger to surgery 11/09/11 [Last modified: Wednesday, November 9, 2011 9:04pm]
Photo reprints | Article reprints

© 2017 Tampa Bay Times


Join the discussion: Click to view comments, add yours

  1. The topic will be neighborhoods as Kriseman, Baker debate one more time


    ST. PETERSBURG — Mayor Rick Kriseman and former mayor Rick Baker will face off, possibly for the last time before the Nov. 7 election, in a candidate forum on Wednesday hosted by the influential Council of Neighborhood Associations.

    St. Petersburg Mayor Rick Kriseman, left, and former Mayor Rick Baker during a September forum. The two will will face off, possibly for the last time before the Nov. 7 election, during  a candidate forum at 7 p.m. Wednesday at the Sunshine Center, 330 5th St. N. [CHERIE DIEZ   |   Times]
  2. Sen. Nelson urges FEMA to examine high number of denied flood claims


    Sen. Bill Nelson urged FEMA on Tuesday to ensure fairness, proper oversight and transparency in processing Hurricane Irma aid following a report by the Palm Beach Post that 90 percent of Irma claims under the National Flood Insurance Program had been denied.

    Sen. Bill Nelson is calling for FEMA to ensure the flood claims process post-Hurricane Irma is fair and ethical following reports that 90 percent of claims under the National Flood Insurance Program were denied. | [Times file photo]
  3. Pasco delays Irma food distribution after problems elsewhere

    Local Government

    DADE CITY — Pasco County has pulled the plug on a planned Food for Florida distribution at the Land O'Lakes Recreation Center that had been scheduled to open to the public on Sunday.

    Pasco County has postponed a planned Food for Florida distribution at the Land O' Lakes Recreation Center on Collier Parkway and is seeking an alternative site. Last week, commissioners said they feared a repeat of the long lines of traffic that appeared outside Plant City Stadium on Oct. 9. The nutrition program for people affected by Hurricane Irma had been scheduled to come to Land O' Lakes Oct. 18 to 27.  [LOREN ELLIOTT   |   Times]
  4. Editorial: UF can set example for free speech


    White nationalist Richard Spencer is bringing his racist message Thursday to the University of Florida in a legitimate, if utterly repugnant, display of the First Amendment at work. As a public university, UF has little choice but to allow Spencer's speech to take place. Now the university and the broader community has …

    By responding with peaceful protests and refusing to be provoked into violence, UF and the Gainesville community can provide a powerful repudiation of Richard Spencer’s hateful message.
  5. Percussionist rocks out with a blazing triangle solo during Florida Orchestra performance


    Oh, the poor triangle. It's the orchestra equivalent of a rock band's tamborine, and such easy fodder for jokes.

    John Shaw performs a triangle solo.