Morbidly Obese Achondroplasic and Bariatric Surgery

Venkata S Kanthimathinathan, MD, John Dockins, MD, Norbert Richardson, MD, Daniel Hoernschemeyer, MD, Archana Ramaswamy, MD, Natalie Suttmoeller, RN CCRN CBN, Roger De La Torre, MD. University of Missouri Health Care

INTRODUCTION: Obesity is a significant and potentially serious health problem in achondroplasia with an incidence of 13 to 43%. Long-term studies show that bariatric surgery in non-achondroplasia patients cause significant loss of weight, better control of diabetes, improvement in cardiovascular risk factors, and a reduction in mortality of 23% from 40%. For the first time, we report a case series of laparoscopic bariatric surgery in morbidly obese achondroplasia patients.

OBJECTIVE: Our aim was to determine whether laparoscopic bariatric surgery improves the quality of life and co-morbidities seen in morbidly obese achondroplasia patients.
METHODS: Two achondroplasia patients with morbid obesity were studied. Patient A was a 42-year-old female, BMI of 57, height of 58 inches, weight of 272 pounds, associated co-morbidities include asthma, sleep apnea, dyspnea on exertion, gastro esophageal reflux disease, hypertension, back pain, stress incontinence, hypercholesterolemia, osteoarthritis and depression. She underwent laparoscopic gastric bypass.
Patient B was a 28-year-old female, BMI of 65, height of 47 inches, weight of 205 pounds; associated co-morbidities include back pain and obstructive sleep apnea. She underwent laparoscopic gastric band.
RESULTS: At 1 year follow-up, patient A’s BMI was 38, weight was 186 pounds. Significant resolution of co-morbidities was seen with regards to hypertension, hypercholesterolemia, back pain, and depression. She has noticed significant improvement in exertional dyspnea and her quality of life.
At 2 year follow-up, patient B’s BMI was 52 and weight was 164 pounds. She has noticed significant improvement in back pain and her quality of life.
CONCLUSION: Obesity in achondroplasia is associated with a higher prevalence of musculoskeletal dysfunctions that interfere with quality of life. So far, very limited data has been published on open bariatric surgery in achondroplasia patients and no data has been published on laparoscopic bariatric surgery on achondroplasics. We did laparoscopic gastric bypass surgery on one patient and laparoscopic gastric banding on the other patient. In our patients, laparoscopic bariatric surgery resulted in resolution of co-morbidities such as hypertension, hypercholesterolemia, back pain, depression and has shown significant improvement in exertional dyspnea and quality of life.
 

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