Faculty Bibliography

BACKGROUND: Many mildly to moderately obese individuals with a body mass index (BMI) lower than 35 kg/m(2) have serious diseases related to their obesity. Nonsurgical therapy is ineffective in the long term, yet surgery has never been made widely available to this population. METHODS: Between 2002 and 2007, 53 patients with a BMI lower than 35 kg/m(2) underwent laparoscopic adjustable gastric banding at our institution. Data on all these patients were collected prospectively and entered into an institutional review board-approved electronic registry. The study parameters included preoperative age, gender, BMI, presence of comorbidities, percentage of excess weight loss (%EWL), and resolution of comorbidities. RESULTS: The mean preoperative age of the patients was 46.9 years (range, 16-68 years), and the mean preoperative BMI was 33.1 kg/m(2) (range, 28.2-35.0 kg/m(2)). Of the 53 patients, 49 (92%) had at least one obesity-related comorbidity. The mean BMI decreased to 28.1 +/- 2.4 kg/m(2), 25.8 +/- 2.9 kg/m(2), and 25.8 +/- 3.1 kg/m(2) and mean %EWL was 48.3 +/- 17.6, 69.9 +/- 28.0, and 69.7 +/- 31.7 at 0.5, 1, and 2 years, respectively. Substantial improvement occurred for the following comorbidities evaluated: hypertension, depression, diabetes, asthma, hypertriglyceridemia, obstructive sleep apnea, hypercholesterolemia, and osteoarthritis. There was one slip, two cases of band obstruction (from food), two cases of esophagitis, and two port leaks, but no mortality. CONCLUSION: The authors are very encouraged by this series of low-BMI patients who underwent laparoscopic adjustable gastric banding. Their weight loss has been excellent, and their complications have been acceptable. Their comorbidities have partially or wholly resolved. With further study, it is reasonable to expect alteration of the weight guidelines for bariatric surgery to include patients with a BMI lower than 35 kg/m(2)

BACKGROUND: To determine which (if any) pre-surgery obesity-related co-morbidities predict complications after bariatric surgery. METHODS: Claims data are analyzed for 1,760 patients aged 18-62 who were covered by one of seven New York State health plans and underwent bariatric surgery during 2002-2005. Data covered 6 months before to 18 months after surgery. Pre-surgery obesity-related comorbidities studied include: diabetes, hyperlipidemia, hypertension, asthma, arthritis, sleep apnea, GERD, and depression. Specific post-surgery complications examined are: stenosis, complications associated with the anastomosis, dumping syndrome, and sepsis. RESULTS: Obesity-related co-morbidities prior to surgery are significantly correlated with the probability of developing complications up to 180 days after bariatric surgery. For example, sepsis was significantly more likely in patients who had diabetes, arthritis, or sleep apnea prior to surgery. An additional pre-surgery comorbidity is associated with a 27.5% higher likelihood of dumping syndrome, 24.5% higher likelihood of complications associated with the anastomosis, and 23.5% higher probability of sepsis in the first 180 days after surgery. Among the individual co-morbidities studied, sleep apnea and GERD are most predictive of complications. CONCLUSION: Patients who exhibit multiple obesity-related co-morbidities prior to bariatric surgery are at significantly elevated risk of post-surgery complications and merit closer monitoring by health care professionals after bariatric surgery. Limitations of this study include nonexperimental data and an unknown degree of under-reporting of pre-surgery co-morbidities in claims data