An estimated 17% (42 million) U.S. adults are active smokers.  Approximately 78 million U.S adults are obese.  Combined the two and you can see how common is for me to see bariatric surgery patients that are active smokers.  Smoking and Bariatric Surgery is a problem for many reasons.  In this post, I will be going over the reasons why you want to quit smoking not only before surgery but also after surgery.

If you are a smoker by now you probably know all the physical damage that cigarettes cause.  I’m sure your primary doctor, family members, and friends have told you to quick smoking in many occasions.  So I’m not going to go over all the side effects of smoking.  I will, however, discuss the ones concerning Smoking and Bariatric Surgery.

My Top 4 Smoking and Bariatric Surgery Complications

Wound Healing

Smokers by nature have decrease wound healing, one of the main reasons is decreased blood flow to tissue due to small capillary occlusion.  During weight loss surgery parts of the intestine and/or stomach are cut and reattached to make the stomach smaller and/or to bypass the intestines.  As you can imaging wound healing is really important to heal this area and to prevent leaks.  The leak rate for a gastric bypass or sleeve gastrectomy is 1-2 % nationwide.  The leak rate for an active smoker is double.  A leak after bariatric surgery could be life-threatening.  We will cover more about leaks in another post.

Wound infections and other types of infection are also more prominent in smokers.  Antibiotic therapy doesn’t get to the tissues as well either due to the decrease blow flow issue mentioned above.

Pulmonary Complications

You probably saw this one coming.  Most people are aware of pulmonary issues due to smoking.  This could be more pronounced on the obese patient.  Many of these patients have sleep apnea and weak respiratory systems due to the weight and lack of physical activities.  Quitting smoking prior to surgery will significantly decrease the chances of having pulmonary complications.

Blood Clots 

Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE) are commonly seen after surgery.  The bariatric patient is more prone to blood clots due to poor circulation and lack of physical activity.  Smokers are also high risk for DVT/PE and in combination with morbid obesity you are at significantly higher risk.  If you are diagnosed with a DVT or PE after surgery you will be placed on a blood thinner for at least 6 months.  This can add issues with bleeding postoperatively or long term.  You will need routine blood tests to monitor the blood thinner levels.   Multiple visits to the doctor’s office.

Stomach Ulcers

Gastric ulcers are very prominent in smokers.  Most ulcers healed by itself without the person knowing that they had ulcers.  This happens mainly because the blood flow to the stomach is so rich.  An ulcer is a wound in the inside of the stomach.  The way the body heal wounds is with blood flow, after bariatric surgery some of the blood flow to the stomach is interrupted because of the way the stomach is divided.  Now that same ulcer that would have healed easily in a normal stomach would not heal as fast or at all.  A pouch ulcer after bariatric surgery can be detrimental to your quality of life.  Imagine having pain every time you eat or presenting to the emergency room with severe abdominal pain because your ulcer perforated and now you need emergency surgery.

For the above mentioned and many other reasons, Smoking and Bariatric Surgery do not match.  In my practice, I require that you QUIT 3 months prior to surgery and forever thereafter.  I will do random urine or blood test to see your compliance.  Just remember you could lie to me as much as you want but at the end of the day, you are lying to YOURSELF.  You are going through weight loss surgery to improve your life and your medical conditions, smoking is not helping.