Kannada actor Chetana Raj’s death: How safe is fat removal surgery?

Kannada actor Chetana Raj, 22, died following post-operative complications after she underwent a “fat removal” surgery at a private hospital in Bengaluru on Monday. Her parents have since alleged that medical negligence led to her death. However, considering the prevalent gaps in protocol, like regarding mandatory pre-assessment of exing medical conditions, one must be aware of the risk factors associated with such surgeries.
Bariatrics counsellor at KD Hospital in Ahmedabad, Dr Pinal Shah, who has been practising in the field for the past 12 years, sheds light on the procedure, its need and attendant risks:
What is fat removal surgery?
Fat removal surgery is generally of two types — bariatric and cosmetic liposuction. The objective of bariatric surgery is to reduce weight and alleviate weight-related disorders or co-morbidities. It is recommended when diet and exercise have been unsuccessful in controlling a person’s body weight or when one has serious health problems due to excess body weight. Certain procedures limit how much you can eat, while others work reducing the body’s ability to absorb nutrients. Some procedures do both.

While bariatric surgery can offer many benefits, all forms of weight-loss surgery are major interventions that can pose serious risks and side effects. Also, one must make permanent healthy changes to one’s diet and get regular exercise to help ensure the long-term success of bariatric surgery. It is considered an option for those whose body mass index (BMI) is 40 or higher (extreme obesity) and those who have serious weight-related health problems, such as type-2 diabetes, high blood pressure or severe sleep apnea. Even if you are dangerously overweight, certain medical guidelines have to be met before undergoing surgery. There has to be an extensive screening process to see if you qualify.

Meanwhile, liposuction is a fat removal method used in cosmetic surgery, more aimed towards aesthetic purposes. Cosmetic fat removal surgery is done under local anesthesia while bariatric surgery is done under general anesthesia. In both cases, pre-operative evaluation must be very thorough so as to avoid complications at a post-operative stage.
What are the risks involved in fat removal surgeries?
The major complication seen in cosmetic fat removal surgeries is that of embolism, or the formation of blood clots, that can turn fatal. In the case of bariatric surgery, there is a two per cent risk of complications arising from the procedure, which is relatively low. Complications are mainly of two types. One is caused due to anesthesia, which may lead to pulmonary clots that can induce a heart attack as an extreme manifestation. This is life-threatening. Other complications can result in sleep apnea.

The second type of complication occurs due to staple-line leak or bleeding, which initially manifests with symptoms of fever, vomiting and can eventually turn fatal if bleeding is excessive and not monitored. While a patient can be discharged after 48 hours of bariatric surgery, a strict follow-up is important over a 21-day period to ensure there is no staple-line leak.
Nonetheless, a thorough pre-operative check-up is mandatory for cosmetic or bariatric surgery. For example, a patient with interstitial lung disease, if operated on without proper preparation, can end up with water accumulating in the lungs. Even if the surgery is successful, the patient has to lead a regulated life so as to not burden the system and ensure that benefits follow.