The role of endoluminal interventions in the preparation of high-risk patients with super-obesity for bariatric surgery
DOI:
https://doi.org/10.30978/GS-2021-1-18Keywords:
morbid obesity, bariatric surgery, type 2 diabetes mellitusAbstract
Obesity causes increased morbidity, disability and mortality rates as well as affects the quality of life. Given the known risks to the patient’s health, the International Federation for the Surgery of Obesity and Metabolic Disorders pays special attention to the problem of morbid obesity (body mass index ≥ 40 kg/m2), with particular emphasis on super‑obesity (body mass index ≥ 50 kg/m2).
Objective is to investigate the role of endoluminal interventions in the preparation of super obese patients with high risk of surgical and anaesthesia‑related complications for bariatric surgery.
Materials and methods. From 2011 to 2018, 97 patients with morbid obesity and high risk of surgery and anaesthesia‑related complications (ASA PS III — IV) underwent a course of treatment at the clinical setting of the Department of General Surgery No2 of Bohomolets National Medical University. The treatment was carried out in 2 stages. In the main group (n = 60), the first stage of treatment included the intragastric balloon placement for a term of 6 months. The control group (n = 37) received a six‑month conservative therapy. In the second stage of treatment the patients of both groups underwent a surgical procedure for the morbid obesity management.
Results. The outcomes of the first stage of treatment showed that the patients, who underwent the intragastric balloon placement, had statistically significantly (p < 0.001) higher mean the percentage of excess weight loss (% EWL) than the patients who received conservative therapy. In the main group, the average ASA PS score, which is identified as an anaesthetic and surgical risk indicator, decreased from 3.28 (95 % confidence interval (CI) 3.17 — 3.40) to 2.15 (95 % CI 2.06 — 2.24, p < 0.001), and in the control group — from 3.24 (95 % CI 3.10 — 3.39) to 3.14 (95 % CI 2.96 — 3.31, p > 0.05).
Conclusions. The results of the study provide strong evidence that the intragastric balloon placement for a term of 6 months reduces surgical and anaesthetic risks, contributes to the improved function of the cardiovascular and respiratory systems as well as gives a boost to carbohydrate metabolism, and, therefore, can be suggested for the preparation of super obese patients with high risk of surgical and anaesthesia‑related complications for bariatric surgery.
References
Ioffe OY, Kryvopustov MS, Tsiura YP. Substantiation of expediency of a two-staged surgical treatment of morbid obesity. Klinicheskaia Khirurgiia. 2018 Aug 30;85(8):49-2. https://hirurgiya.com.ua/index.php/journal/article/view/491.
Ioffe OY, Tsiura YP, Stetsenko OP, Tarasiuk TV, Kryvopustov MS, Molnar IM. Preoperative preparation opportunities for radical surgery in patients with morbid obesity. Surgery of Ukraine. 2014;(2):38-42.
Mitchenko OI, Lavrik AS, Shkroba АO, Romanov VY. Effect of medical and surgical treatment of obesity on cardiovascular risk in patients with arterial hypertension and morbid obesity. Ukrainian Journal of Cardiology. 2014;(4):17-25.
DeMaria EJ, Murr M, Byrne TK, et al. Validation of the obesity surgery mortality risk score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity. Ann Surg. 2007 Oct;246(4):578-82.
DeMaria EJ, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis. 2007 Mar-Apr;3(2):134-40.
Ioffe OYu, Kryvopustov MS, Dibrova YA, Tsiura YP. Type 2 diabetes mellitus remission and its prediction after two-stage surgical treatment of patients with morbid obesity. Wiad Lek. 2019;72(5):739-43.
Logue J, Thompson L, Romanes F, Wilson DC, Thompson J, Sattar N. Management of obesity: summary of SIGN guideline. BMJ. 2010 Feb 24;340:c154.
Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient — 2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Endocr Pract. 2013 Mar-Apr;19(2):337-72.
Pineda E, Sanchez-Romero L, Brown M, et al. Achieving the 2025 WHO global health body-mass index targets: a modelling study on progress of the 53 countries in the WHO European region. The Lancet. 2016;388:S90.
Rooney KD, Werrett GC. Obesity & Anaesthesia [Internet]. [cited 2018 May 20]. Available from: http://www.anaesthesiauk.com/documents/ obesity.pdf
Sapala JA, Wood MH, Schuhknecht MP, Sapala MA. Fatal pulmonary embolism after bariatric operations for morbid obesity: a 24-year retrospective analysis. Obes Surg. 2003 Dec;13(6):819-25.
Yoshizawa T, Ishikawa K, Nagasawa H, et al. A fatal case of super-super obesity (BMI > 80) in a patient with a necrotic soft tissue infection. Intern Med. 2018 May 15;57(10):1479-81.
Sallet JA, Marchesini JB, Paiva DS, et al. Brazilian multicenter study of the intragastric balloon. Obes Surg. 2004 Aug;14(7):991-8.
Busetto L, Segato G, De Luca M, et al. Preoperative weight loss by intragastric balloon in super-obese patients treated with laparoscopic gastric banding: a case-control study. Obes Surg. 2004 May;14(5):671-6.
Dumonceau JM. Evidence-based review of the Bioenterics intragastric balloon for weight loss. Obes Surg. 2008 Dec;18(12):1611-7.
Angrisani L, Lorenzo M, Borrelli V, Giuffre M, Fonderico C, Capece G. Is bariatric surgery necessary after intragastric balloon treatment? Obes Surg. 2006 Sep;16(9):1135-7.
Mathus-Vliegen L, Toouli J, Fried M, et al. Obesity: WGO Global Guideline [Internet]. 2011 [cited 2018 May 20]. Available from: http://www.worldgastroenterology.org/UserFiles/file/guidelines/obesity-english-2011.pdf.
