Outcome of Portal Injuries Following Bariatric Operations

Background: Portal vein thrombosis is rare following Roux-en-Y gastric bypass (RYGBP). Its natural history is dependent on the etiology of the thrombosis. Iatrogenic injuries at bariatric operations resulting in portal vein thrombosis are lethal complications typically necessitating a liver transplant, whereas postoperative portal vein thrombosis without an injury to the portal vein has a benign course. There are currently no data on management or prognostic factors of portal vein thrombosis after bariatric operations. Methods: 3 patients referred for liver transplantation secondary to portal vein injury following bariatric surgery between 2000 and 2003 are presented. Results: 2 super-obese (BMI ≥50 kg/m²) and 1 morbidly obese (BMI 44 kg/m²) patients sustained portal vein injuries during bariatric surgery (RYGBP 2, VBG 1) by experienced bariatric surgeons. In each case, the portal injury was identified and repaired. Thrombosis followed reconstruction in all 3 patients. All 3 underwent emergency liver transplantation, but died of sepsis and multi-organ failure following transplantation. Review of the literature found no cases of traumatic portal vein injuries following bariatric operations and 2 cases of postoperative portal vein thrombosis: 1 following LRYGBP (BMI 46) and one after a Lap-Band (BMI 41). Conclusion: Injury to the portal vein resulting from difficulty in discerning the anatomy of the intra-abdominal structures in the morbidly obese, is a lethal complication of bariatric surgery. Super-obese patients submitting to bariatic surgery should lose weight, undergo a two-stage bariatric procedure, or undergo laparoscopic RYGBP to minimize the risk of portal injury. Postoperative portal vein thrombosis has a benign course and can be managed conservatively.     

Technique of resection of esophageal adenocarcinoma after Roux-en-Y gastric bypass and literature review of esophagogastric tumors after bariatric procedures

BackgroundThe number of bariatric procedures has continued to increase worldwide. However, experience with tumors arising in the esophagus or stomach after gastric bypass is lacking. We report our technique for curative resection of esophageal adenocarcinoma in a patient who had undergone previous gastric bypass and review the reported data on esophagogastric tumors after bariatric surgery.MethodsWe have described the operative details of esophagectomy after gastric bypass and reviewed the published data regarding type of bariatric surgery, gender predilection, presentation, symptom duration, cancer stage, and prognosis of patients with esophagogastric tumors occurring after bariatric surgery.ResultsOnly 22 esophagogastric tumors have been reported so far after bariatric surgery. The majority of them are locally advanced or metastatic at presentation.ConclusionEsophagogastric tumors after bariatric surgery are uncommon. This operative technique pays particular attention to the altered anatomy, dissection of the gastric pouch, and preservation of the blood supply to the excluded stomach. This technique can also be applied to manage tumors arising in the gastric pouch after previous gastric bypass. Close collaboration with the bariatric surgeon during surgery is essential to achieve a successful oncologic outcome in this subset of patients.     

Bariatric surgery: A safe and effective conduit to cardiac transplantation

BackgroundObesity and obesity-related co-morbidities, including advanced heart failure, are epidemic. Some of these patients will progress to require cardiac allografts as the only means of long-term survival. Unfortunately, without adequate weight loss, they may never be deemed acceptable transplant candidates. Often surgical weight loss may be the only effective and durable option for these complex patients. The objective of this study was to assess whether bariatric surgery is feasible and safe in patients with severe heart failure, which in turn, after adequate weight loss, would allow these patients to be listed for a heart transplant.MethodsFour patients who underwent bariatric procedures, such as laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (SG), for the purpose of attaining adequate weight loss with the goal to improve their eligibility for orthotopic heart transplants are presented.ResultsAll patients did well around the time of surgery, and 3 of the 4 progressed to receiving a heart transplant. The fourth patient will be listed pending attaining adequate weight loss.ConclusionBariatric surgery may be an important bridge to transplantation for morbidly obese patients with severe heart failure. With the appropriate infrastructure, bariatric surgery is a feasible and effective weight loss method in this population.     

Adjustable gastric banding as revisional bariatric procedure after failed gastric bypass—intermediate results

BackgroundAlthough gastric bypass is the most common bariatric procedure in the United States, it is has been associated with a failure rate of 15% (range 5–40%). The addition of an adjustable gastric band to Roux-en-Y gastric bypass has been reported to be a useful revision strategy in a small series of patients with inadequate weight loss after proximal gastric bypass.MethodsWe report on 22 patients who presented with inadequate weight loss or significant weight regain after proximal gastric bypass. All patients underwent revision with the placement of an adjustable silicone gastric band around the proximal gastric pouch. The bands were adjusted at 6 weeks postoperatively and beyond, as needed. Complications and weight loss at the most recent follow-up visit were evaluated.ResultsThe mean age and body mass index at revision was 41.27 years (range 25–58) and 44.8 ± 6.34 kg/m², respectively. Patients had experienced a loss of 19%, 27%, 47.3%, 42.3%, 43%, and 47% of their excess weight at 6, 12, 24, 36, 48, and 60 months after the revisional procedure, respectively. Three major complications occurred requiring reoperation. No band erosions have been documented.ConclusionThe results from this larger series of patients have also indicated that the addition of the adjustable silicone gastric band causes significant weight loss in patients with poor weight loss outcomes after gastric bypass. That no anastomosis or change in absorption is required makes this an attractive revisional strategy. As with all revisional procedures, the complication rates appear to be increased compared with a similar primary operation.     

Protein deficiency after gastric bypass: The role of common limb length in revision surgery

BackgroundBariatric surgery, especially the gastric bypass procedure, is an effective therapy for morbid obesity, but may reduce protein absorption and induce protein deficiency (PD). A recent study reported an issue about common limb length for PD.ObjectiveThis study aimed to examine the prevalence of PD after gastric bypass surgery and investigate the role of common limb length in PD-related revision surgery.SettingHospital-based bariatric center.MethodsFrom 2001 to 2016, 2397 patients with morbid obesity who underwent bariatric/metabolic surgery with 1-year follow-up were recruited. Serum albumin and total protein were measured before and 1 year after surgery. Medical records of patients who underwent revision surgery due to PD were reviewed.ResultsThe overall prevalence of PD was .5% preoperatively. The prevalence of PD increased to 2.0% at 1 year after surgery. The incidence was highest in one-anastomosis gastric bypass (2.8%) followed by Roux-en-Y gastric bypass (1.8%). Until the end of follow-up, all 19 patients who underwent revision surgery for intractable PD had a relatively short common limb length of <400 cm. After elongation of the common limb length to >400 cm in revision surgery, PD improved in all patients.ConclusionsA subset of patients can develop PD after gastric bypass surgery when the common limb length is <400 cm. In patients with intractable PD after gastric bypass surgery, revision surgery for elongation of common limb length to >400 cm is mandatory to avoid PD-related complications.     

Outcome following resectional gastric bypass for failed bariatric surgery

PurposeAn increasing number of patients who have failed a primary bariatric procedure are presenting for revisional surgery. There are few studies examining the outcome following any revisional surgery, and none examining resectional gastric bypass (RGB) in this role. We examine the indications, outcome, and patient satisfaction following conversion of a prior bariatric procedure to the RGB.MethodsFrom May 1992 to May 1998, 38 patients underwent RGB as a conversion from prior bariatric operations. Weight loss, indications, and complications were reviewed. A patient survey was used to examine patient satisfaction.ResultsMean body mass index decreased from 46 to 33 kg/m² following revision to RGB. Median weight loss after revision to RGB was 34 kg. From the time of the initial bariatric procedure to post-RGB, mean body mass index decreased from 52 to 33 kg/m². Patients with pre-RGB Visick scores of 3 or 4 improved following RGB. Ninety-five percent of respondents were satisfied with the RGB, and 85% thought it improved their lives. Constant nausea and vomiting and failure of weight control were the most common indications for revision.ConclusionsResectional gastric bypass is a safe and effective revisional procedure for patients who have had failed or complicated bariatric surgery.     

Risk factors for acute respiratory failure in bariatric surgery: data from the Nationwide Inpatient Sample, 2006–2008

BackgroundAcute respiratory failure (ARF) can be a life-threatening postoperative complication after bariatric surgery and is defined as the presence of acute respiratory distress or pulmonary insufficiency. We sought to identify predictors of ARF in patients who underwent bariatric surgery.MethodsUsing the Nationwide Inpatient Sample database, from 2006 to 2008, the clinical data from morbidly obese patients who underwent bariatric surgery were examined. Multivariate regression analysis was performed to identify the independent factors predictive of ARF. The factors examined included patient characteristics, co-morbidities, payer type, teaching status of hospital, surgical techniques (laparoscopic versus open), and type of bariatric operation (gastric bypass versus nongastric bypass).ResultsA total of 304,515 patients underwent bariatric surgery during the 3-year period. The overall ARF rate was 1.35%. The greatest rate of ARF (4.10%) was observed after open gastric bypass surgery. The ARF rate was lower after laparoscopic than after the open surgical technique (.94% versus 3.87%, respectively; P < .01) and after nongastric bypass versus gastric bypass (.82% versus 1.54%, respectively; P < .01). Using multivariate regression analysis, congestive heart failure (adjusted odds ratio [AOR] 5.1), open surgery (AOR 3.3), chronic renal failure (AOR 2.9), gastric bypass (AOR 2.5), peripheral vascular disease (AOR 2.4), male gender (AOR 1.9), age >50 years (AOR 1.8), Medicare payer (AOR 1.8), alcohol abuse (AOR 1.8), chronic lung disease (AOR 1.6), diabetes mellitus (AOR 1.2), and smoking (AOR 1.1) were factors associated with greater rates of ARF. Compared with patients without ARF, patients with ARF had significantly greater in-hospital mortality (5.69% versus .04%, P < .01).ConclusionWe identified multiple risk factors that have an effect on the development of acute respiratory failure after bariatric surgery. Surgeons should consider these factors in surgical decision-making and inform patients of their risk of this potentially life-threatening complication.     

Gastropleural fistula after single anastomosis gastric bypass. A case report and review of the literature

IntroductionPulmonary complications after bariatric surgeries are rare but usually serious. They often occur early after surgery but the presentation might be delayed for several months. Gastropleural fistula after bariatric surgery is extremely rare and has been reported in a very small number of patients post sleeve gastrectomy and gastric bypass.Case presentationA 37-year-old lady presented with left sided pleural effusion and empyema 2 years post single anastomosis gastric bypass surgery. She was found to have a large gastropleural fistula and was managed by surgical repair of the fistula with conversion to gastric bypass and decortication of the affected pleura. That resulted in significant clinical improvement and resolution of the empyema.ConclusionGastropleural fistula is a very rare complication of bariatric surgeries and should be considered in patients who present with chronic or recurrent pulmonary infections.     

Combined liver transplantation and sleeve gastrectomy for end-stage liver disease in a bariatric patient: First European case-report

IntroductionObesity is a contributor to the global burden of chronic diseases, including non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH). NASH cirrhosis is becoming a leading indication for liver transplant (LT). Obese transplanted patients have higher morbidity and mortality rates. One strategy, to improve the outcomes in these patients, includes bariatric surgery at the time of LT. Herein we report the first European combined LT and sleeve gastrectomy (SG).Case presentationA 53 years old woman with Hepatocellular carcinoma and Hepatitis C virus related cirrhosis, was referred to our unit. She also presented with severe morbid obesity (BMI 40 kg/m²) and insulin-dependent diabetes. Once listed for LT, she was assessed by the bariatric surgery team to undergo a combined LT/SG. At the time of transplantation the patient had a model for end-stage liver disease calculated score of 14 and a BMI of 38 kg/m².The LT was performed using a deceased donor. An experienced bariatric surgeon, following completion of the LT, performed the SG. Operation time was 8 h and 50 min. The patient had an uneventful recovery and is currently alive, 5 months after the combined procedure, with normal allograft function, significant weight loss (BMI = 29 kg/m²), and diabetes resolution.ConclusionDespite the ideal approach to the management of the obese LT patients remains unknown, we strongly support the combined procedure during LT in selected patients, offering advantages in terms of allograft and patient survival, maintenance of weigh loss that will ultimately reduce obese related co-morbidities.     

Magnetic device in reduced port and single port bariatric surgery: First 170 cases experience

IntroductionMagnetic devices have been successfully used in bariatric surgery. To the date, the only reported use of the magnet was for liver retraction. Our purpose in this study is to demonstrate the safety and viability of using a magnetic system in different steps in single port and reduced port bariatric surgery.MethodsProspective and observational study was performed. Patients older than 18 years, undergoing primary laparoscopic sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and Roux-en-Y gastric bypass (RYGB) or revisional surgery by single-port or reduced-port approach between July 2020 and June 2021 were included.ResultsA total of 170 patients (mean BMI, 41.47kg/m²; mean age 36.92 yrs) completed laparoscopic bariatric surgery (54 single-port sleeve gastrectomy [SPSG], 16 reduced-port SG, 83 RYGB, 4 OAGB and 14 revision surgeries), using the magnetic surgical system in different steps of the surgery. Mean surgical time for SPSG and reduced-port SG was 65.52min and 59.36min respectively; and for RYGB 74.19min, OAGB 70.98min, and revisional surgeries 88.38min. As for intraoperative complications, 2.94% mild liver laceration without significant bleeding was reported. There were no 30-day mortalities and no major complications.ConclusionMagnetic assistance in single-port and reduced-port bariatric surgery is an innovative technique. With this prospective study we attempt to demonstrate the safety profile and potential uses that may improve the implementation of new surgical approaches in bariatric surgery.     

Bariatric surgery decreased the serum level of an endotoxin-associated marker: lipopolysaccharide-binding protein

BackgroundRecent studies have shown serum lipopolysaccharide binding protein (LBP) is associated with obesity and related metabolic disorder. Bariatric surgery can significantly reduce weight, but reports about the change of LBP after bariatric surgery are limited. We investigated LBP concentration and its associations with clinical variables.MethodsWe enrolled 178 obese patients receiving different bariatric surgeries and 38 normal weight individuals. Fasting blood samples were collected at baseline in all and 1 year after surgery in obese individuals. The serum LBP concentration was measured.ResultsThe percentage of excess weight loss of mini-gastric bypass, Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric band were 72.0±20.0%, 65.5±23.0%, 67.2±18.4%, and 16.1±14.3%, respectively. Serum LBP levels were higher in the obese participants than in the normal weight participants (49.9±15.7 versus 25.2±7.5 μg/mL; P<.001) at baseline and significantly decreased to 35.1±22.6 μg/mL after bariatric surgery (P<.001) in the obese group. In the bariatric participants, after multivariate analyses, preoperative LBP and the change of LBP with surgery were independently associated only with high sensitive C-reactive protein (hs-CRP) (P<.001) and the change of hs-CRP (P = .012), respectively, while none of the postoperative variables was independently associated with LBP.ConclusionLBP is associated with body mass index and hs-CRP. Bariatric surgery significantly decreased the serum level of LBP. The relationship between LBP and hs-CRP disappeared after bariatric surgery. (Surg Obes Relat Dis 2014;0:000–000.) © 2014 American Society for Metabolic and Bariatric Surgery. All rights reserved.     

Laparoscopic bariatric surgery for those with body mass index of 70–125 kg/m2

BackgroundData on laparoscopic bariatric surgery in the extremely obese are limited. Technical difficulties, in addition to the patients' severe weight-related co-morbidities, can compromise the safety of bariatric surgery in these patients. Our objectives were to assess the safety and feasibility of laparoscopic bariatric surgery in extremely obese patients and to compare the outcomes of different surgical approaches at a bariatric surgery center of excellence in an academic medical center.MethodsWe reviewed our prospectively collected database and identified all patients with a body mass index (BMI) of ≥70 kg/m² who had undergone bariatric surgery. The data on patient demographics, baseline characteristics, and outcomes of bariatric surgery were retrieved.ResultsA total of 49 patients with a mean BMI of 80.7 kg/m² (range 70–125) underwent 61 bariatric procedures. Of the 49 patients, 26 underwent sleeve gastrectomy, 11 gastric bypass, and 12 underwent a 2-stage procedure (sleeve gastrectomy followed by gastric bypass). At a mean follow-up of 17.4 months, the average BMI had decreased to 60.9 kg/m² (36% excess weight loss). Overall, the patients who underwent a 2-stage procedure achieved greater percentage of excess weight loss (54.5%) than did those who underwent either single-stage sleeve gastrectomy or gastric bypass (25.4%, P = .002 and 43.8%, P = .519, respectively). Of the 61 cases, 60 (98.4%) were completed laparoscopically. The early complication rate was 16.4% overall; most were minor complications. The late complication rate was 14.8%. A single late mortality occurred in this series.ConclusionLaparoscopic bariatric surgery can be performed safely on patients with a BMI of ≥70 kg/m². A staged approach might offer better weight loss results.     

Two-year changes in health-related quality of life in gastric bypass patients compared with severely obese controls

BackgroundFew weight loss surgery trials have evaluated the changes in health-related quality of life (HRQOL) relative to obese individuals not participating in weight loss interventions. In a prospective study at a bariatric surgery practice, we evaluated the 2-year changes in HRQOL in gastric bypass patients compared with 2 severely obese groups who did not undergo surgical weight loss.MethodsA total of 308 gastric bypass patients were compared with 253 individuals who sought but did not undergo gastric bypass and 272 population-based obese individuals using the weight-related (Impact of Weight on Quality of Life-Lite) and general (Medical Outcomes Study 36-item Short-Form Health Survey) HRQOL questionnaires at baseline and 2 years of follow-up.ResultsThe percentage of weight loss was 34.2% for the gastric bypass and 1.4% for the no gastric bypass groups, with a .5% gain for population-based obese group. Both measures of HRQOL showed greater improvements for the gastric bypass group, even after controlling for baseline differences. Effect sizes for changes in physical and weight-related HRQOL were very large for gastric bypass, but small to medium for the 2 comparison groups. Effect sizes for changes in the psychosocial aspects of HRQOL were moderate to very large for gastric bypass, but small for the 2 comparison groups. Of the gastric bypass patients, 97% had meaningful improvements in the Impact of Weight on Quality of Life-Lite total score compared with 43% of the no gastric bypass group and 30% of the population-based obese group.ConclusionDramatic improvements had occurred in weight-related and physical HRQOL for gastric bypass patients at 2 years after surgery compared with 2 severely obese groups who had not undergone surgery. These results support the effectiveness of gastric bypass surgery in improving patients' HRQOL.     

Gastric bezoar after Roux-en-Y gastric bypass for morbid obesity: A case report

IntroductionWe aimed to present a patient with gastric pouch bezoar after having a bariatric surgery.Presentation of caseSixty-three years old morbid obese female had a laparoscopic Roux-en-Y gastric bypass surgery 14 months ago. She has lost 88% of her excess body mass index; but started to suffer from nausea, abdominal distention and vomiting lately, especially for the last two months. The initial evaluation by endoscopy, computed tomography (CT) and an upper gastrointestinal contrast series overlooked the pathology in the gastric pouch and did not display any abnormality. However, a second endoscopy revealed a 5 cm in diameter phytobezoar in the gastric pouch which was later endoscopically removed. After the bezoar removal, her complaints relieved completely.DiscussionThe gastric bezoars may be confused with the other pathologies because of the dyspeptic complaints of these patients. The patients that had a bariatric surgery; are more prone to bezoar formation due to their potential eating disorders and because of the gastro-enterostomy made to a small gastric pouch after the Roux-en-Y gastric bypass surgery.ConclusionPossibility of a bezoar formation should be kept in mind in Roux-en-Y gastric bypass patients who has nausea and vomiting complaints. Removal of the bezoar provides a dramatic improvement in the complaints of these patients.     

Severe fatal protein malnutrition and liver failure in a morbidly obese patient after mini-gastric bypass surgery: Case report

IntroductionMini-gastric bypass (MGB) is a bariatric surgical technique popular in many centers due to shorter duration, easier technique, and excellent weight loss results. However, it may be associated with postoperative malnutrition. This case describes the clinical course and unfortunate outcome of a morbidly obese patient who underwent MGB and developed malnutrition in the first postoperative year.Presentation of caseA 37 year-old female patient with a BMI of 44 kg/m² successfully underwent MGB surgery in June 2015 and was discharged uneventfully. She presented with lower extremity edema and generalized weakness 8 months later, with a blood albumin level of 3.1 g/dL, compared to a normal preoperative value. She was admitted and received a high-protein diet, and her clinical condition improved. Three months after her discharge, she was readmitted with the same complaints, as well as pancytopenia. She was also hypocupremic. After unsuccessful intensive supportive measures, she finally underwent revisional gastrogastrostomy. However, she developed signs and symptoms of profound liver failure postoperatively (albumin 1.8 g/dL; total bilirubin 7.5 mg/dL; prothrombin time 34 s) and pancytopenia persisted. All resuscitative measures were unsuccessful and she expired in July 2016.DiscussionMultiple factors can contribute to postoperative malnutrition and liver dysfunction after MGB, including the presence of baseline liver disease, inadequate diet supplementation, leaving a too-short common small intestinal channel, and ethnic variations in small bowel length. These factors should also be considered when deciding to perform corrective surgery.ConclusionCareful, individualized treatment and follow-up plans may help to prevent such catastrophic consequences.     

Effect of Bariatric Surgery on Liver Fibrosis

Background

Although bariatric surgery has been shown to improve hepatic steatosis in morbidly obese patients, the effect of weight loss on hepatic fibrosis has not been determined. Since the prognosis of patients with nonalcoholic fatty liver disease is closely related to the development of hepatic fibrosis, it is important to determine the hepatic histology of these patients after weight loss. We therefore evaluated the prevalence of hepatic fibrosis in morbidly obese patients undergoing bariatric surgery and assessed the correlation of histologic changes with weight loss.

Methods

We retrospectively evaluated 78 morbidly obese patients who underwent gastric bypass. Liver biopsies were taken during surgery and after weight loss, and the correlations between histologic findings and hepatic fibrosis were determined.

Results

Of the 78 patients, 35 (44.8%) had fibrosis at first biopsy, and 24 (30.8%) had hepatic fibrosis after weight loss, including 19 of the 35 patients (54.3%) with fibrosis at first biopsy and 5 of the 43 (11.6%) without hepatic fibrosis at first biopsy (P?=?0.027).

Conclusions

Weight loss in morbidly obese patients was associated with a reduction in the prevalence of hepatic fibrosis.     

Six-year changes in health-related quality of life in gastric bypass patients versus obese comparison groups

BackgroundFew studies have evaluated the long-term outcomes of bariatric surgery patients in relation to obese individuals not participating in weight loss interventions. Our objective was to evaluate the 6-year changes in health-related quality of life (HRQOL) in gastric bypass (GB) patients versus 2 obese groups not undergoing surgical weight loss. The study setting was a bariatric surgery practice.MethodsA total of 323 GB patients were compared with 257 individuals who sought but did not undergo gastric bypass and 272 population-based obese individuals using weight-specific (Impact of Weight on Quality of Life-Lite) and general (Medical Outcomes Study Short-Form 36 Health Survey) HRQOL questionnaires at baseline and 2 and 6 years later.ResultsAt 6 years, compared with the controls, the GB group exhibited significant improvements in all domains of weight-specific and most domains of general HRQOL (i.e., all physical and some mental/psychosocial). The 6-year percentage of excess weight loss correlated significantly with improvements in both weight-specific and physical HRQOL. The HRQOL scores were fairly stable from 2 to 6 years for the GB group, with small decreases in HRQOL corresponding to some weight regain.ConclusionsGB patients demonstrated significant improvements in most aspects of HRQOL at 6 years compared with 2 nonsurgical obese groups. Despite some weight regain and small decreases in HRQOL from 2 to 6 years postoperatively, the HRQOL was relatively stable. These results support the effectiveness of weight loss achieved with gastric bypass surgery for improving and maintaining long-term HRQOL.     

Longitudinal cost experience for gastric bypass patients

BackgroundTo assess the effect of gastric bypass surgery on the total cost of medical care for morbidly obese members compared with obese members and a general population.MethodsWe used an observational pre–post test design to analyze the administrative claim records of 224 gastric bypass patients during 3 periods (preoperative, surgical, and postoperative years) for a total of 7.5 years. The estimated future care costs for gastric bypass patients were determined from their preoperative cost trends, adjusting for the annualized actuarial trends. The general membership population actuarial trends and overweight/obese member medical expenditure data were used as comparison groups.ResultsThe inflation adjusted mean per member per year total paid decreased by $1895 in the fifth year after surgery. The mean costs for gastric bypass patients were lower within the first year after surgery than their preoperative costs. At 3.5 years after surgery, the surgical costs had been recouped for patients undergoing gastric bypass surgery, and by year 2, they had incurred fewer costs than the obese health plan population.ConclusionAlthough gastric bypass is a costly surgical procedure, the longitudinal costs savings and overall health improvement for patients undergoing gastric bypass surgery are cost-effective within a closed, experienced network. Weight loss surgery decreased the annual costs per patient in the years after surgery. The costs were slightly elevated in the fifth year after surgery because of maternity cases and orthopedic surgeries.     

Outcome of bariatric surgery on hypothyroidism: experience from a tertiary care center in India

BackgroundHypothyroidism is frequently found to be associated with morbid obesity. Effect of bariatric surgery on type 2 diabetes, hypertension, and sleep apnea has been studied extensively but there is a dearth of literature on its impact on thyroid function. We had published our experience of laparoscopic sleeve gastrectomy and its effect on hypothyroidism in morbidly obese patients previously. In this study, we have tried to evaluate the impact of bariatric surgery on the whole cohort of hypothyroid patients and compare the effect of various bariatric procedures on thyroid hormone replacement dose.ObjectiveTo assess outcome of bariatric surgery on the hypothyroid patients and to compare the outcomes of laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, and one-anastomosis gastric bypass in terms of reduction of thyroid hormone replacement dosage.SettingTertiary care University Hospital, India; Government Practice.MethodsThis is a retrospective analysis of a database of all bariatric procedures done in a single unit at a tertiary care teaching hospital in India. Morbidly obese patients with hypothyroidism on thyroxine replacement were identified and their preoperative and postoperative thyroid hormone replacement dosage (THR) and thyroid stimulating hormone levels were compared.ResultsOf 883 patients undergoing bariatric surgery, 180 patients were hypothyroid (on thyroxine replacement). Ninety-three patients were included in the final analysis. The mean age of the study population was 42.2 ± 10.4 years and the mean preoperative body mass index was 47.8 ± 8.3 kg/m². Mean follow-up duration was 29.8 ± 19.6 months. The excess weight loss was 58.9%. Fifty-two (55.8%) patients had a decrease in the in THR dosage, 37 (39.8%) had no change in THR dosage, and 4 patients required an increase in THR dosage. Decrease of THR dose was observed in 61.7% patients in laparoscopic sleeve gastrectomy in comparison to 45.4% in bypass group.ConclusionBariatric surgery might cause reduction of thyroid replacement dosage in hypothyroid, morbidly obese patients.