Jessica Ardila-Gatas, MD, Gautam Sharma, MD, Zubaidah Nor-Hanipah, MD, Chao Tu, MS, Ali Aminian, MD, Leslie Tolle, MD, Philip R Schauer, MD. Cleveland Clinic
Introduction: Perioperative pulmonary complications are frequent in patients with Interstitial Lung Diseases (ILDs). Minimum literature exists regarding the safety of bariatric procedures in patients with ILD. This study aims to assess the safety, feasibility and outcomes of patients with ILDs who underwent bariatric surgery at our institution.
Methods: After IRB approval, all patients with preoperative diagnosis of ILDs who had bariatric surgery at an academic center between 2004 and 2014 were retrospectively reviewed. Data collected included patients demographics, baseline co-morbidities, pulmonary function tests (PFTs), peri- and post-operative outcomes. Data was summarized as medians with interquartile range for continuous variables and as counts with percentages for categorical variables. Wilcoxon rank sum test was used to compare paired continuous variables.
Results: A total of 25 patients with ILDs underwent bariatric surgery: Roux-en-Y gastric bypass (n=17, 68%), sleeve gastrectomy (n=7, 28%), and adjustable gastric banding (n=1, 4%). Twenty one patients (84%) were females. The median age and preoperative body mass index (BMI) were 53 (42-58) years and 39 (37-44) kg/m2, respectively. The median operative time and length of stay was 137 (110-187) minutes and 3 (2-5) days, respectively. The 30-day complications were reported in 4 patients (16%) and included: anastomotic leak requiring reoperation (n=1), marginal ulcer (n=1), and anastomotic strictures (n=2). There was no 30-day pulmonary complication or unplanned admission to intensive care unit. At 1-year follow-up (85%), the median BMI and excess weight loss were 30 (25-36) kg/m2 and 67% (45-100), respectively. Compared to preoperative values, there was significant improvement in the PFT variables at 1 year with respect to forced vital capacity (62% vs 74%; n=13, p=0.003), and diffusing capacity of the lungs for carbon monoxide (53% vs 66%; n=10, p=0.003). Six out of the 7 potential lung transplant candidates became eligible for transplantation after weight loss, and one of them had successful lung transplant at 88 months after bariatric surgery.
Conclusion: Patient with morbid obesity and ILD constitute a high risk group. Bariatric surgery in these patients would be safe with acceptable perioperative morbidity, significant weight loss, and improved candidacy for lung transplantation. Our data also showed significant improvement in the PFTs in the short-term follow up. Multidisciplinary team approaches to patient care is essential in this high risk cohort.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88110
Program Number: S042
Presentation Session: Bariatrics 2 Session
Presentation Type: Podium