Why Smoking is Bad For You

 

Smoking is one of the most addictive habits around the world.

Even though giving up smoking can be hard, being able to kick the habit will significantly improve your outcomes when it comes to bariatric surgery. We now know that smoking can have significant negative impacts on your ability to heal.

 

Here are several reasons why:

Impaired Blood Flow:

• Nicotine and other chemicals in cigarettes: These substances constrict blood vessels, reducing blood flow to tissues. Good blood flow is essential for healing, especially along the staple line of the newly formed stomach sleeve.

Delayed Healing:

• Oxygen delivery: Smoking reduces the amount of oxygen that reaches tissues, further delaying the healing process. This is crucial because adequate oxygenation is necessary for tissue repair and integrity.

Increased Inflammation:

• Inflammatory response: Smoking increases the body’s inflammatory response, which can impair healing and increase the risk of infection. Inflammation can compromise the integrity of the staple line, making it more susceptible to leaks.

Decreased Immune Function:

• Immune suppression: Smoking weakens the immune system, reducing the body’s ability to fight off infections that might develop if a leak occurs.

Gastrointestinal Effects:

• Increased acid production: Smoking can increase stomach acid production, which can exacerbate irritation and erosion at the staple line, further increasing the risk of a leak.

This is why smoking has been proven to be associated with negative outcomes when it comes to bariatric surgery which can lead to serious consequences.

 

• Sleeve specific risks:
  • Increased sleeve leak: Smoking is known to significantly increase the risk of leak after gastric sleeve. According to studies, the rate of leak is doubled after smoking (0.6% vs 0.3%) [1].
• Bypass specific risks
  • Anastomotic leaks: The join between the stomach and intestines (anastomosis) may be more likely to leak in smokers, resulting in serious infections and complications.
  • Increased risk of ulcers: Smokers are at higher risk for developing ulcers in the stomach and intestines after surgery. Smoking is an independent and statistically significant predictor of the development of MUs with a 4.6-fold greater risk (P= .003) [2]

As a result, smoking is an absolute contra-indication for bypass surgery and we would not recommend bypass surgery for patients who have an active history of smoking.

 

In addition to the specific bariatric risks, smoking can also lead to Increased Surgical Complications in the peri-operative period:

• Wound healing issues:
  • Smoking impairs blood flow, which can delay healing and increase the risk of wound infections.
• Lung problems:
  • Patients who smoke, are more likely to experience respiratory complications during and after surgery.
• Heart problems:
  • Patients who smoke are also at higher risk of heart issues in the peri-operative period
• Delayed recovery:
  • The overall recovery process can be slower for smokers, impacting the success of the surgery.

The cessation of smoking for 4-6 weeks prior to surgery and after surgery will help to minimise some of these risk factors. There is strong evidence to suggests that it would be even better to have not smoked for one year before pursuing bariatric surgery [3].

 

What about Vaping?

Vaping, like smoking, can have negative impacts on bariatric surgery outcomes.

While vaping is sometimes perceived as less harmful than smoking, it still poses significant risks for individuals undergoing bariatric surgery. The presence of nicotine and other chemicals can impair healing, increase inflammation, and contribute to complications such as wound infections, respiratory issues, and anastomotic leaks. There is still a lack of comprehensive long-term studies on the effects of vaping, making it difficult to fully understand its impact on surgical outcomes compared to traditional smoking.

 

What is our recommendations?

• Stopping smoking prior to surgery:
  • Bariatric surgery programs often recommend or require patients to stop smoking or vaping at least 4-6 weeks before surgery. It would be even more ideal to have quit smoking or vaping entirely for 1 year before undergoing bariatric procedures. This allows the body time to recover and reduces the risk of complications.

• Continued abstinence:
  • To promote optimal healing and long-term success, we would recommend and encourage patients to utilise the opportunity of having bariatric surgery in quitting smoking/ vaping altogether.
• Support programs:
  • There are many smoking/vaping support programs to help patients quit the habit. Remember, you don’t have to do it all on your own and seeking professional advice while using aids can significantly improve your chance of giving it all up together.

 

Reference

Dittrich et al., 2020. Marginal ulcers after laparoscopic Roux-en-Y gastric bypass: Analysis of the amount of daily and lifetime smoking on postoperative risk. Surgery for Obesity and Related Diseases; 16(3): 389-396

https://www.sciencedirect.com/science/article/abs/pii/S1550728919311244

 

MR Janik et al., 2021. The effect of smoking on bariatric surgical 30-day outcomes. Surgical Endoscopy; 35:3905–3914

https://link.springer.com/article/10.1007/s00464-020-07838-4

 

A Chow et al., 2020. Smoking in bariatric surgery: a systematic review. Surgical endoscopy. https://doi.org/10.1007/s00464-020-07669-3

https://cmcoem.info/pdf/curso/tabaquismo/tabaquismoencirugia.pdf