Management of Laryngotracheal Stenosis in Obesity. Is This Another Co-morbidity that Can Be Improved with Weight Loss Following Bariatric Surgery?

Matyas Fehervari,Shivali Patel,Kevin Haire,Guri Sandhu,Evangelos Efthimiou,Rebecca Towning,Atika Sabharwal,Chadwan Al Yaghchi

doi:10.1007/s11695-021-05647-9

Abstract

PurposeBariatric surgery improves several obesity-related comorbidities. Laryngotracheal stenosis is a rare condition that is usually managed with repeated endoscopic airway interventions and reconstructive airway surgery. The outcome of these definitive operations is worse in individuals with obesity. There are no studies investigating the effect of weight loss following bariatric surgery in the management of laryngotracheal stenosis.Materials and MethodsIn an observational study, consecutive patients with a BMI over 35 kg/m2 and laryngotracheal stenosis were prospectively recruited to a bariatric and airway stenosis database in two tertiary care centres. Patients were treated with laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy and control subjects were managed conservatively.ResultsA total of eleven patients with an initial body mass index of 43 kg/m2 (37–45) were enrolled to this study. Six patients underwent bariatric surgery and five subjects were treated conservatively. After 12 months, the total weight loss of patients undergoing bariatric surgery was 19.4% (14–24%) whilst 2.3% (1–3%) in the control group. The annual number of endoscopic airway interventions following bariatric surgery reduced (p = 0.002). Higher weight loss in patients led to less frequent interventions compared to control subjects (p = 0.004). Patients undergoing laryngotracheal reconstruction following bariatric surgery needed less endoscopic intervention, an annual average of 1.9 interventions before vs 0.5 intervention after. Conservatively managed control subjects required more frequent endoscopic intervention, 1.8 before vs 3.4 after airway reconstruction.ConclusionBariatric surgery reduced the number of endoscopic airway interventions and enabled patients to undergo successful definitive airway reconstructive surgery.

Highlights

Obesity is associated with multiple comorbidities such as diabetes, obstructive sleep apnoea, cancer, and cardiovascular disease [1]
Six patients underwent bariatric surgery, 3 patients did not fulfil the NICE guidelines for bariatric surgery, and 2 patients decline to have a weight loss procedure
None of the 6 patients undergoing surgery was considered suitable for definitive airway reconstruction prior to weight loss procedure and 2 of the subjects with more severe Laryngotracheal stenosis (LTS) and other significant comorbidities such as super obesity and cardiovascular disease were considered not fit for laparoscopic Roux-en-Y gastric bypass (LRYGB) despite this would have been the preferred surgical option

Summary

Introduction

Obesity is associated with multiple comorbidities such as diabetes, obstructive sleep apnoea, cancer, and cardiovascular disease [1]. These conditions are commonly deteriorating with worsening of obesity whilst weight loss leads to remission of comorbidities [2, 3]. Obesity-related all-cause mortality and morbidity shows a decrease following BS [8]. Most guidelines such as NICE or NIH recommends metabolic surgery for patients with BMI over 40 kg/m2 or BMI greater than 35 kg/m2 in patients with weight-related comorbidities [9, 10]

Methods

Results

Conclusion