Monica T Young, MD, Joshua M Mourot, MD, Hope T Jackson, MD, Alejandro Rodriguez, MD, Andrew S Wright, MD, Marcelo Hinojosa, MD, Brant K Oelschlager, MD, Ganesh Raghu, MD, Saurabh Khandelwal, MD. University of Washington Medical Center
Introduction: Morbidly obese patients with advanced interstitial lung disease (ILD) face two important challenges: rapid deterioration of lung function and ineligibility for lung transplantation. No studies have been published describing outcomes of bariatric surgery in this patient population. The aim of this study was to evaluate the effects of RYGB on pulmonary function in patients with ILD.
Methods and Procedures: We reviewed bariatric referrals at our institution between 2009 and 2013 and identified patients with a concurrent diagnosis of interstitial lung disease who underwent RYGB. Data was collected on patient characteristics, comorbidities and pulmonary function. Weight and pulmonary function testing were recorded every 6 months for duration of follow-up. Postoperative outcomes were calculated from data at most recent visit. Main outcome measures were postoperative changes in forced vital capacity (FVC), percent predicted values (PPV) and BMI.
Results: Five patients were identified and analyzed. Etiologies of their ILD included idiopathic pulmonary fibrosis (N=2), non-specific interstitial pneumonia (N=2) and sarcoidosis (N=1). All patients were female with a mean age 47 years old.
| Preop Mean (N=5) | Postop Mean* (N=5) | p-value | |
|---|---|---|---|
| BMI (kg/m2) | 48 | 31.6 | p<0.01 |
| FVC (Liters) | 1.88 | 2.3 | p=0.16 |
| Predicted Value (%) | 59 | 73 | p=0.09 |
*Mean length of follow-up 38 ± 17 months.
Mean length of stay was 3 days. Postoperative complications included one 30-day readmission for acute renal insufficiency and a rectus sheath hematoma. There were no mortalities. Three patients (60%) achieved BMI transplant criteria of <30 kg/m2.
Conclusions: All patients undergoing laparoscopic RYGB exhibited post-operative improvement in their FVC as well as their PPV, with a mean improvement of 14% predicted value over 38 months. RYGB surgery in the morbidly obese patient with ILD can be performed with acceptable morbidity and mortality by a multidisciplinary team with expertise in pulmonary medicine and bariatric surgery. Given the lack of effective therapies for ILD, RYGB may offer the potential to not only slow decline but also improve pulmonary function and help patients achieve transplant BMI requirements.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79824
Program Number: P478
Presentation Session: Poster (Non CME)
Presentation Type: Poster
