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Is Bariatric Surgery Safe and Effective in Patients with Inflammatory Bowel Disease?

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Abstract

Background

The rate of obesity is rapidly increasing in patients with inflammatory bowel disease (IBD), but whether bariatric surgery in patients with IBD is safe and effective is not well understood.

Methods

A retrospective review of patients with IBD undergoing bariatric surgery across a multi-state health system was performed. Thirty-day postoperative outcomes, weight loss, and long-term complications were recorded.

Results

Thirty-one patients (81% female) with IBD and a mean preoperative body mass index (BMI) of 42.4 kg/m2 underwent 32 bariatric operations (n = 14 Roux-en-Y gastric bypass, n = 14 sleeve gastrectomy, n = 4 gastric band). Short-term infectious complications included superficial surgical site infection (n = 2), infected intra-abdominal hematoma (n = 1), and a hepatic abscess (n = 1). Percent excess weight loss was 57.2% (n = 25) at 6 months, 62.9% (n = 22) at 12 months, and 57.4% (n = 11) at 24 months. No IBD flares requiring surgery were observed at a median follow-up of 2.7 years (interquartile range, 0.8–4.2 years).

Conclusion

In carefully selected patients with IBD, bariatric surgery appears safe with respect to short-term infectious complications and results in sustained weight loss until at least 2 years postoperatively.

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References

  1. Seminerio JL et al. Impact of obesity on the management and clinical course of patients with inflammatory bowel disease. Inflamm Bowel Dis. 2015;21(12):2857–63.

    Article  Google Scholar 

  2. Harper JW, Sinanan MN, Zisman TL. Increased body mass index is associated with earlier time to loss of response to infliximab in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19(10):2118–24.

    Article  Google Scholar 

  3. Bultman E et al. Predictors of dose escalation of adalimumab in a prospective cohort of Crohn’s disease patients. Aliment Pharmacol Ther. 2012;35(3):335–41.

    Article  CAS  Google Scholar 

  4. Gupta PK, Franck C, Miller WJ, et al. Development and validation of a bariatric surgery morbidity risk calculator using the prospective, multicenter NSQIP dataset. J Am Coll Surg. 2011;212(3):301–9.

    Article  Google Scholar 

  5. Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA. 2018;319(3):255–65.

    Article  Google Scholar 

  6. Salminen P, Helmiö M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA. 2018;319(3):241–54.

    Article  Google Scholar 

  7. Colombo F, Rizzi A, Ferrari C, et al. Bariatric surgery in patients with inflammatory bowel disease: an accessible path? Report of a case series and review of the literature. J Crohns Colitis. 2015;9(2):185–90.

    Article  Google Scholar 

  8. Aelfers S, Janssen IMC, Aarts EO, et al. Inflammatory bowel disease is not a contraindication for bariatric surgery. Obes Surg. 2018;28(6):1681–7.

    Article  Google Scholar 

  9. Aminian A, Andalib A, ver M, et al. Outcomes of bariatric surgery in patients with inflammatory bowel disease. Obes Surg. 2016;26(6):1186–90.

    Article  Google Scholar 

  10. Heshmati K, Lo T, Tavakkoli A, et al. Short-term outcomes of inflammatory bowel disease after Roux-en-Y gastric bypass vs sleeve gastrectomy. J Am Coll Surg. 2019;228(6):893–901. e1

    Article  Google Scholar 

  11. Keidar A, Hazan D, Sadot E, et al. The role of bariatric surgery in morbidly obese patients with inflammatory bowel disease. Surg Obes Relat Dis. 2015;11(1):132–6.

    Article  Google Scholar 

  12. Sharma P, McCarty TR, Njei B. Impact of bariatric surgery on outcomes of patients with inflammatory bowel disease: a Nationwide Inpatient Sample analysis, 2004-2014. Obes Surg. 2018;28(4):1015–24.

    Article  Google Scholar 

  13. Bazerbachi F, Sawas T, Vargas EJ, et al. Bariatric surgery is acceptably safe in obese inflammatory bowel disease patients: analysis of the Nationwide Inpatient Sample. Obes Surg. 2018;28(4):1007–14.

    Article  Google Scholar 

  14. Shoar S, Shahabuddin Hoseini S, Naderan M, et al. Bariatric surgery in morbidly obese patients with inflammatory bowel disease: a systematic review. Surg Obes Relat Dis. 2017;13(4):652–9.

    Article  Google Scholar 

  15. Hudson JL et al. Bariatric surgery is a safe and effective option for patients with inflammatory bowel diseases: a case series and systematic review of the literature. Inflamm Intest Dis. 2019;3(4):173–9.

    Article  Google Scholar 

  16. Satsangi J, Silverberg MS, Vermeire S, et al. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55(6):749–53.

    Article  CAS  Google Scholar 

  17. Brethauer SA, Kim J, el Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11(3):489–506.

    Article  Google Scholar 

  18. McKenna NP et al. Intra-abdominal sepsis after ileocolic resection in Crohn’s disease: the role of combination immunosuppression. Dis Colon Rectum. 2018;61(12):1393–402.

    PubMed  Google Scholar 

  19. Morar PS, Hodgkinson JD, Thalayasingam S, et al. Determining predictors for intra-abdominal septic complications following ileocolonic resection for Crohn’s disease-considerations in pre-operative and peri-operative optimisation techniques to improve outcome. J Crohns Colitis. 2015;9(6):483–91.

    Article  Google Scholar 

  20. Tzivanakis A et al. Influence of risk factors on the safety of ileocolic anastomosis in Crohn’s disease surgery. Dis Colon Rectum. 2012;55(5):558–62.

    Article  CAS  Google Scholar 

  21. McKenna NP et al. Risk factors for organ space infection after ileal pouch anal anastomosis for chronic ulcerative colitis: an ACS NSQIP analysis. Am J Surg. 2018;216(5):900–5.

    Article  Google Scholar 

  22. Hicks CW, Hodin RA, Bordeianou L. Possible overuse of 3–stage procedures for active ulcerative colitis. JAMA Surg. 2013;148(7):658–64.

    Article  Google Scholar 

  23. Kiely JM, Fazio VW, Remzi FH, et al. Pelvic sepsis after IPAA adversely affects function of the pouch and quality of life. Dis Colon Rectum. 2012;55(4):387–92.

    Article  Google Scholar 

  24. Geltzeiler CB et al. Initial surgical management of ulcerative colitis in the biologic era. Dis Colon Rectum. 2014;57(12):1358–63.

    Article  Google Scholar 

  25. Goodman SM, Springer B, Guyatt G, et al. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty. Arthritis Care Res. 2017;69(8):1111–24.

    Article  Google Scholar 

  26. Causey MW, Johnson EK, Miller S, et al. The impact of obesity on outcomes following major surgery for Crohn’s disease: an American College of Surgeons National Surgical Quality Improvement Program assessment. Dis Colon Rectum. 2011;54(12):1488–95.

    Article  Google Scholar 

  27. Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003;138(9):957–61.

    Article  Google Scholar 

  28. Sippey M et al. 30-day readmissions after sleeve gastrectomy versus Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2016;12(5):991–6.

    Article  Google Scholar 

  29. Kellogg TA, Swan T, Leslie DA, et al. Patterns of readmission and reoperation within 90 days after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5(4):416–23.

    Article  Google Scholar 

  30. Dorman RB, Miller CJ, Leslie DB, et al. Risk for hospital readmission following bariatric surgery. PLoS One. 2012;7(3):e32506.

    Article  CAS  Google Scholar 

  31. Main WPL, Murphy AE, Hussain LR, et al. Thirty-day readmission rate using an outpatient infusion pathway after laparoscopic Roux-en-Y gastric bypass. Am Surg. 2018;84(9):1429–32.

    PubMed  Google Scholar 

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Acknowledgments

The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery provides salary support for Dr. Habermann and in kind support for Dr. McKenna. Dr. McKenna received salary support from the Mayo Clinic Clinical Investigator Training Program. These funding sources did not affect our investigation.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    Nicholas P. McKenna, Elizabeth B. Habermann & Alaa Sada

  2. The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Mayo Clinic, Rochester, MN, USA

    Nicholas P. McKenna, Elizabeth B. Habermann & Alaa Sada

  3. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Elizabeth B. Habermann

  4. Division of Breast, Endocrine, Metabolic, and Gastrointestinal Surgery, Mayo Clinic, Rochester, MN, USA

    Todd A. Kellogg & Travis J. McKenzie

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  1. Nicholas P. McKenna
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  2. Elizabeth B. Habermann
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Correspondence to Nicholas P. McKenna.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This was a retrospective review and for this type of study, formal consent is not required.

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Presentation

The accompanying abstract was presented as a quick shot presentation at the 2019 Society for Surgery of the Alimentary Tract Annual Meeting as part of Digestive Diseases Week in San Diego, CA on May 18, 2019.

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McKenna, N.P., Habermann, E.B., Sada, A. et al. Is Bariatric Surgery Safe and Effective in Patients with Inflammatory Bowel Disease?. OBES SURG 30, 882–888 (2020). https://doi.org/10.1007/s11695-019-04267-8

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  • DOI: https://doi.org/10.1007/s11695-019-04267-8

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