Bariatric surgery in inflammatory bowel disease: a comparative analysis of 450,000 patients

Abstract

BackgroundStudies were conducted to investigate the outcomes of bariatric surgery (BS) among inflammatory bowel disease (IBD) patients. ObjectivesWe aimed to analyze previous literature, comparing the outcomes of BS between IBD and non-IBD patients. SettingNot applicable. MethodsPubMed, Scopus, and Web of Science were searched on 25/9/2023 for comparative studies on outcomes of BS in IBD patients. RevMan Software v5.4 was used to conduct the analysis. ResultsOur analysis revealed an insignificant difference in the change of body mass index (BMI) at 1-year post-BS between IBD and non-IBD patients. IBD patients had a higher risk of acute renal failure, hemorrhage, and readmission following BS (RR: 2.16, 95% CI: 1.55–3, RR: 1.57, 95% CI: 1.22–2.04, RR: 1.56, 95% CI: 1.17–2.08, respectively). No significant difference was observed between both groups regarding wounds, leak/intra-abdominal infection, thromboembolic complications, and bowel obstruction. A higher incidence of postoperative complications was seen among IBD patients undergoing RYGB compared with SG (RR: 2.21, 95% CI: 1.43–3.41). There was a significant decline in steroid use following BS in IBD patients (RR: .67, 95% CI: .53–.84). Comparison between UC and Crohn’s disease (CD) revealed insignificant differences in treatment escalation or de-escalation. Both IBD and non-IBD patients had similar lengths of hospitalization. ConclusionsBS is equally effective in IBD and non-IBD patients in terms of weight loss at 1-year follow-up. Nevertheless, IBD patients are at a higher risk of postoperative complications, micronutrient deficiency, and readmission. Both UC and CD reported a decline in steroid use following surgery without a preferential advantage to a particular IBD sub-type.