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Smoking After Bariatric Surgery: Risks & Guidelines

Smoking is one of the most common addictive habits around the world, with the latest polling signaling that nearly one-in-four adults in the world smoke tobacco[1]. Given those metrics, we can also know that giving up smoking is very hard, especially for people who have been doing it for most of their lives. There are many reasons why tobacco users want or need to stop smoking; for women, it may be that they found out that they’re pregnant or to prevent their children from being exposed to second-hand smoke. 

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For others, it may be due to health related issues. Smoking can cause or worsen many medical conditions and researchers estimate that every year around eight million people die an early death due to smoking. According to the CDC[2], smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Smoking also increases risk for tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis.


Patients from all different backgrounds arrive at LIMARP® because they’re looking to improve their quality of life and embark on a healthier path. Our multidisciplinary team, led by Dr. Liza María Pompa González, offers different health services to help you reach your weight goals and beat obesity: from diet and exercise plans, to psychological guidance and bariatric surgery. When it comes to bariatric surgery, a doctor will determine which procedure is right for you and if you qualify, they will provide a series of instructions for before and after the surgery.


One of those indications will be to stop smoking and in this article, we’ll discuss the dangers of smoking following bariatric surgery and the complications it can bring.

Smoking is bad for your health no matter the circumstance, but it’s especially important to kick this habit if you want to ensure a healthy and successful recovery.

Can a Patient Smoke after Bariatric Surgery?

The short answer is no and prior to surgery, you’ll be instructed to stop smoking up to six weeks prior to bariatric surgery. This is to avoid complications during the surgery and prolong the recovery process; smoking can also cause problems in the heart and in the lungs, which are organs that must be healthy in order to have a successful bariatric surgery. There are many things a patient can do to ensure fast healing and great results after weight loss surgery. When preparing for bariatric surgery and recovery from the procedure, avoiding tobacco products is crucial. In fact, smoking has a number of negative effects on your overall health and wellness. 


Following the surgery, the doctor will provide instructions for the recovery period, from dietary suggestions to the gradual inclusion of physical activity to the patient’s lifestyle.  Smoking and using any sort of tobacco products prior to a surgical procedure can lead to an increased risk of infection and poor healing times.

Link Between Smoking and Obesity

While many people believe that smoking can help people lose weight or keep excessive weight off, there’s been some evidence that smoking can actually cause people to put on weight.


A study published in the April 2014 issue of the journal Obesity found that people who smoke tend to have worse diets than non-smokers. The study found that women who smoke are more likely to have fatty foods or diets that are high in carbs. Even if the smoker is not necessarily obese, their diet can contribute to weight gain as well as a number of serious health problems.

The Dangers of Smoking After Bariatric Surgery

After bariatric surgery, the dangers of smoking persist. Smoking after any sort of surgical procedure can lead to problems with healing and recovery, and while it doesn’t have a direct impact on weight loss outcomes, it can increase the risk of other complications, such as infections and ulcers. It can also increase the patient’s possibility of developing diabetes and heart disease, which are conditions that are commonly solved or treated with bariatric surgery.  


Like pre-op prep for surgery, it’s crucial that smokers avoid tobacco products of any kind for a few weeks after surgery. This is particularly important in those early weeks of healing as you are getting used to your new dietary needs. According to one study[2], “smoking is highly associated with long-term, post-operative complications, marginal ulceration, and bone fracture to name a few”. 


When it comes to specific types of bariatric surgeries, smoking can affect the body differently according to the type of procedure the patient underwent. During a gastric bypass, a new stomach pouch is formed in your body, and if the patient continues to smoke after the surgery, it can cause the narrowing of the entrance of this pouch. The result will be severe pain, vomiting, and nausea.


Tobacco causes a decrease in the blood flow to your stomach pouch because it shrinks the blood vessels. The carbon monoxide produced when smoking affects your blood cells’ ability to carry oxygen and as a result, the slow healing after bariatric surgery becomes a long-term concern.


Other Complications

The lungs of smokers are already damaged and it takes up to 12 months for them to function normally. After weight loss surgery, the patient might experience breathing difficulties and a compromised immune system. If they smoke after surgery, even if not instantly after the procedure, the lungs are at the risk of infections, pneumonia, or other respiratory complications.

Ulceration is already a risk for smokers and bariatric surgery is one of the factors that increase the risk of ulcers in all individuals. This means that the probability doubles in smoking patients. The body heals ulcers usually by pumping blood to the stomach, but if after the gastric sleeve or gastric bypass surgery, the stomach is smaller than its original size which decreases your body’s ability to heal ulcers.

Smoking also causes ulcer medication treatment dysfunction, so the use of medications is also discarded.

The poor blood circulation resulting from weight loss surgery increases the risk of blood clots for gastric bypass patients. Less than 1% of patients experience the entrance of blood clots into the lungs and heart, and eventually, pulmonary embolism.

The ability to pump blood is even less in smoking patients which increases this number for them. Blood clots in smoking bariatric patients cause blood pressure, strokes, and heart attack more than in non-smoker patients.

The blockage of veins causes decreased blood flow in smokers. As a result, the healing process after the bariatric procedures slows down, bringing a lot of concerns for wound infections in smoking patients.

This is a logical concern because if there is not enough oxygenated blood pumped into the surgical wound, the healing does not go as usual and will cause infections in the sections where intestines were cut and stapled, which is a matter of concern in gastric bypass and sleeve surgery patients.

Making Healthy Lifestyle Choices Following Surgical Weight Loss

Bariatric surgery is all about changing your habits and your lifestyle for the better. We recommend to many of our patients that they quit using tobacco products after they have undergone a surgical weight loss procedure. This helps with healthy living overall. 

A healthier diet, more exercise, and a smoke-free life all signal the turning of the page and the start of a new you.

Contact Us to Learn More

If you want to learn more about the dangers of smoking after bariatric surgery, schedule an appointment with one of our doctors. We can help determine the right treatment for you. Contact us online anytime or give us a call at (619) 373-0229.

References

[1] “Smoking”. https://ourworldindata.org/smoking. (Accessed May 21, 2022).

[2] Chow, A., Neville, A. & Kolozsvari, N. Smoking in bariatric surgery: a systematic review. Surg Endosc 35, 3047–3066 (2021). https://doi.org/10.1007/s00464-020-07669-3

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LIMARP

INTERNATIONAL CENTER OF EXCELLENCE FOR OBESITY


Dr. Pompa is a member of several distinguished organizations, where she attends meetings regularly and serves as faculty at:

  • Mexican Association of General Surgery
  • Mexican College of Obesity and Metabolic Surgery
  • Fellow of the American College of Surgeons
  • American Association of Surgery for Obesity and Metabolic diseases as an international member
  • International Bariatric Club
  • Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)
  • French Society for Digestive Surgery
  • American Diabetes Association
  • Harvard Alumnin Association

To schedule your consultation, contact our Tijuana practice online or call us at: USA (619) 270-8823