Laparoscopic Bariatric Surgery for the Treatment of Severe Hypertriglyceridemia

Wei-jei Lee, MD PhD, Jung-chien Chen, MD, Kong-han Ser, MD, Jun-juin Tsou, SPN, Yi-chih Lee, MHA. Min-Sheng General Hospital, National Taiwan University, Taiwan

Background: Severe hypertriglyceridemia is an established cause of pancreatitis. Medical treatment for patients with severe hypertriglyceridemia and repeat pancreatitis attacks are not satisfactory.
Methods: A review of 20 morbid obese patients with severe hypertriglyceridemia ( a triglyceride level of more than 1000 mg/dl) who received laparoscopic bariatric surgery was performed. The series consisted of 14 males and 6 females, with an average of 35.0 years (from 24 to 52) and the mean BMI was 38.2 (from 25 to 53). The preoperative mean plasma triglyceride was 1782.7 mg/dl (from 1043 to 3884). Four patients had a history of hypertriglyceridemic pancreatitis and 13 had associated diabetes.
Results: Of the 20 patients, 17 (85%) received gastric bypass, 3 (15%) received restrictive type surgery. Laparoscopic access was used in all the patients. Hypertriglyceridemia in morbid obese patients were associated with male gender and a not well controlled diabetes state. The mean BMI decreased to 28.7 (24.9% reduction) one year after surgery with a great improvement in diabetes control. The markedly elevated plasma triglyceride levels decreased to 254 mg/dl (from 153 to 519) at one month after surgery and to 192mg/dl (from 73 to 385) at one year. One patient developed acute pancreatitis at peri-operative period but none of the patient has had an episode of pancreatitis at follow-up (from 6months to 13 years).
Conclusions: Bariatric surgery can be used as a metabolic surgery in severe hypertriglyceridemia patients at risk of acute pancreatitis. Control of hypertriglyceridemia before bariatric surgery is indicated.
 

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