Vertical Sleeve Gastrectomy

[GADD45B]

Doctor,
I have a female pilot friend who is obese with a BMI of 41. She is otherwise healthy with no other health problems, other than being overweight. With years of unsuccessful attempts at diets, she is opting to have this VSG procedure in Mexico. It seems like it's basically a full or nearly full gastrectomy. My question is, do you think this is safe and the right thing to do? And also, how will this affect her medical certification?

Thanks!

[My Flight Surgeon]

As with any major surgery, gastric bypass carries risks such as bleeding, infection and an adverse reaction to the anesthesia. Possible risks specific to this surgery include:
§ Death. A risk of death has been associated with gastric bypass surgery. The risk varies depending on age, general health and other medical conditions. Talk to your doctor about the exact level of risk gastric bypass surgery may pose for you.
§ Blood clots in the legs. Blood clots in the legs are more likely to occur in very overweight people. Blood clots can be dangerous. In some cases, they travel to the lungs and lodge in the lungs' arteries causing a pulmonary embolism — a serious condition that damages lung tissue and can lead to death. Walking and using leg wraps that apply intermittent pressure to the leg can help reduce this risk of blood clots in the legs.
§ Leaking at one of the staple lines in the stomach. This severe postoperative problem would be treated with antibiotics. Most cases heal with time. Sometimes, the leak can be serious enough to require emergency surgery.
§ Pneumonia. Excess weight places extra stress on the chest cavity and lungs. This means a higher risk of developing pneumonia after the surgery.
§ Narrowing of the opening between the stomach and small intestine. This rare complication may require either an outpatient procedure to pass a tube through your mouth to widen (dilate) the narrowed opening or corrective surgery.
Gastric bypass can also cause dumping syndrome, a condition where stomach contents move too quickly through the small intestine causing nausea, vomiting, diarrhea, dizziness and sweating. Other common complications of gastric bypass surgery include:
§ Vitamin and mineral deficiency
§ Dehydration
§ Gallstones
§ Bleeding stomach ulcer
§ Hernia at the incision site
§ Intolerance to certain foods






The FAA does allow pilots to fly after weight loss surgery. The airman must be at least 3 months post-operative, with no com­plications and demonstrate metabolic balance with blood sugar, electrolyte, serum calcium, and phosphorous levels.

Weight loss surgery is not a panacea.