Jingjing L Sherman, MD1, Dmitry Nepomnayshy, MD, FACS2. 1Englewood Hospital, 2Lahey Hospital and Medical Center
Introduction: Obesity is becoming more prevalent in patients with inflammatory bowel disease (IBD). The obese body habitus increases the complexity of surgeries that are often needed to treat IBD. Some surgeons may delay definitive surgical treatment because of obesity. Little data exists on bariatric surgery in the obese patient with IBD.
Methods: We retrospectively identified 17 patients who had known diagnosis of IBD who underwent bariatric surgery from 2006 to 2016. Demographics and post-operative outcomes were assessed.
Results: 17 patients were identified: 8 with ulcerative colitis (UC) and 9 with Crohn’s disease (CD). Of the 8 UC patients, none of the patients had surgery for UC and only one was on a biologic. Of the 8 UC patients, 2 had adjustable gastric band (AGB), 1 had gastric bypass and 5 had sleeve gastrectomy. One patient with AGB had it replaced for slip and subsequently removed for dysphagia. UC preoperative BMI average was 43.5. Postoperative BMI was 32.4 with excess weight loss (EWL) of 57%. Average follow up was 23 months.
Of the 9 CD patients, 4 patients had ileocolic resections and one had total proctocolectomy with end ileostomy. One was on Remicade and one on 6MP. Of the CD patients, 5 had AGB, 1 had gastric bypass and 3 had sleeve gastrectomy. One AGB patient had conversion to gastric bypass because of dysphagia and poor weight loss. A second ABG patient had band removal because of dysphagia. CD patients’ preoperative BMI average was 43.1. Postoperative BMI was 37.0 with average EWL of 30%. Average follow up was 37 months.
Overall, AGB patients had 17% EWL, sleeves 51% and gastric bypass 74%. Two UC patients had post-operative flares, one immediately post op and one month post-operative. Four of the 7 band patients had dysphagia, with one replacement, two removals and one conversion to bypass. There were no leaks, intraabdominal infections, fistulas or wound infections.
Conclusions: UC patients appear to have higher excess weight loss compared to Crohn’s patients; EWL 57% compared to 30% but was not statistically significant. AGB had poor results in both UC and CD patients. Sleeve gastrectomy and gastric bypass results in effective weight loss for obese patients with IBD. Gastric bypass in IBD patient is controversial, but may be appropriate in the right clinical setting.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84939
Program Number: P552
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster