Why Emergency Room Physicians Don’t Understand How To Take Care Of Patients Who Have Recently Undergone Bariatric Surgery

Here is something we have learned at G. Eric Nielsen & Associates from hard experience over many years: People who undergo weight loss surgery (bariatric surgery) are at risk for severe post-surgical complications for several months. Bariatric surgery is not like gallbladder surgery. It is not like an appendectomy. When the surgeon removes your diseased gallbladder or your infected appendix, you will typically require 2 to 4 weeks to completely heal. You will be at risk for severe postoperative complications for only a few days.

Bariatric surgery patients are different.

When a patient undergoes weight loss surgery, the period of postoperative risk may be as long as 6 to 12 months.

The patient’s body has to learn to digest food in a new way. The surgery represents a major disruption to the digestive tract. Patients can experience tremendous complications for weeks, even months after the surgery: pulmonary embolism, stricture, gastric narrowing which prevents the passage of food and fluid, infection, malnutrition. They can also suffer from a vitamin B1 (thiamine) deficiency which can cause a severe brain injury known as Wernicke’s encephalopathy.

Doctors in the emergency room don’t always recognize this. The typical emergency room physician thinks that a patient’s “danger zone” following ordinary abdominal surgery is 2 to 4 weeks. When a bariatric surgery patient comes into the ER two months after the procedure, the typical emergency room may or may not recognize that the patient is still in danger.

If you get so sick after bariatric surgery that you find it necessary to go to the emergency room, make sure the doctor knows exactly what kind of surgery you had and when you had it. Explain everything you can to the doctor. Beg the doctor to call your bariatric surgeon and let him or her know what’s going on. Give the emergency room doctor your surgeon’s phone number and contact information. This is very important.

Bariatric surgery offers a tremendous benefit for many patients. But it can be dangerous. We have represented individuals who developed profound thiamine deficiencies after bariatric surgery. This condition leads to Wernicke’s encephalopathy, a disease which can kill or cripple the patient if left untreated. Some of our clients went to the emergency room repeatedly trying to get medical help for their intractable nausea and vomiting, but doctors missed the diagnosis until it was too late.


The symptoms of Wernicke’s encephalopathy are ataxia (unsteady or weak gait), nystagmus (vision disturbances) and mental confusion. At the first sign of any of these symptoms, call your bariatric surgeon and go to the hospital immediately. Some patients report dizziness and blurry vision.

How much weight is typical after major bariatric surgery?  In extreme cases, it is possible for a patient to lose 30 pounds in the first month after surgery. However, weight loss should slow down after the first month. It is concerning for a patient to lose 30 pounds during the next month.

If you experience more than that, be vigilant and let your surgeon know exactly what’s happening, especially if you are experiencing unusual levels of nausea and vomiting. If you have any reason to believe that your body is not absorbing your daily vitamin pill (because you’re throwing up so often), be sure and call your surgeon immediately.