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Bariatric surgery in patients with interstitial lung disease

  • 2018 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Perioperative pulmonary complications are frequent in patients with interstitial lung diseases (ILD). Limited literature exists regarding the safety of bariatric procedures in patients with ILD. This study aims to assess the safety, feasibility, and outcomes of patients with ILD who underwent bariatric surgery at our institution.

Methods

After IRB approval, all patients with preoperative diagnosis of ILD who had bariatric surgery at an academic center between 2004 and 2014 were retrospectively reviewed.

Results

A total of 25 patients with ILD underwent bariatric surgery: Roux-en-Y gastric bypass (n = 17, 68%), sleeve gastrectomy (n = 7, 28%), and adjustable gastric banding (n = 1, 4%). Twenty-one patients (84%) were females. The median age and preoperative body mass index (BMI) were 53 (IQR 42–58) years and 39 (IQR 37–44) kg/m2, respectively. The median operative time and length of stay was 137 (IQR 110–187) min and 3 (IQR 2–5) days, respectively. The 30-day complications were reported in four patients (16%) but there was no pulmonary complication or unplanned admission to the intensive care unit. At 1-year follow-up (85%), the median BMI and excess weight loss were 30 (IQR 25–36) kg/m2 and 67% (IQR 45–100), respectively. Compared to preoperative values, there was significant improvement in the pulmonary function test (PFT) variables at 1 year with respect to forced vital capacity (62% vs 74%; n = 13, p = 0.003), and diffusing capacity of the lungs for carbon monoxide (53% vs 66%; n = 10, p = 0.003). Six out of the seven potential lung transplant candidates became eligible for transplantation after weight loss, and one of them had successful lung transplant at 88 months after bariatric surgery.

Conclusion

In our experience, bariatric patients with ILD achieved significant weight loss and improvement in PFT. Bariatric surgery in these higher risk ILD patients appears relatively safe with acceptable perioperative morbidity and improved candidacy for lung transplantation.

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Authors and Affiliations

  1. Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Ave/A100, Cleveland, OH, 44195, USA

    Jessica Ardila-Gatas, Gautam Sharma, Zubaidah Nor Hanipah, Stacy A. Brethauer, Ali Aminian & Philip R. Schauer

  2. Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia

    Zubaidah Nor Hanipah

  3. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    Chao Tu

  4. Department of Pulmonary Medicine and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA

    Leslie Tolle

Authors
  1. Jessica Ardila-Gatas
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  2. Gautam Sharma
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  3. Zubaidah Nor Hanipah
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  4. Chao Tu
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  5. Stacy A. Brethauer
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  6. Ali Aminian
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  7. Leslie Tolle
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  8. Philip R. Schauer
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Corresponding author

Correspondence to Philip R. Schauer.

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Disclosures

Stacy A Brethauer is a speaker and consultant from Medtronic and Ethicon. Philip R. Schauer received grants and personal fees from Ethicon, grants from Medtronic, personal fees from GI Dynamics, personal fees from The Medicines Company, grants and personal fees from Pacira, personal fees from Novo Nordisk, and personal fees from Neurotronics. Jessica Ardila-Gatas, Gautam Sharma, Zubaidah Nor Hanipah, Chao Tu, Ali Aminian, and Leslie Tolle have no conflicts of interest or financial ties to disclose.

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Ardila-Gatas, J., Sharma, G., Nor Hanipah, Z. et al. Bariatric surgery in patients with interstitial lung disease. Surg Endosc 33, 1952–1958 (2019). https://doi.org/10.1007/s00464-018-6475-7

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  • DOI: https://doi.org/10.1007/s00464-018-6475-7

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