The role of endoluminal interventions in the preparation of high-risk patients with super-obesity for bariatric surgery

Abstract

Obesity causes increased morbidity, disability and mortality rates as well as affects the quality of life. Given the known risks to the patient’s health, the International Federation for the Surgery of Obesity and Metabolic Disorders pays special attention to the problem of morbid obesity (body mass index ≥ 40 kg/m2), with particular emphasis on super‑obesity (body mass index ≥ 50 kg/m2). Objective is to investigate the role of endoluminal interventions in the preparation of super obese patients with high risk of surgical and anaesthesia‑related complications for bariatric surgery. Materials and methods. From 2011 to 2018, 97 patients with morbid obesity and high risk of surgery and anaesthesia‑related complications (ASA PS III — IV) underwent a course of treatment at the clinical setting of the Department of General Surgery No2 of Bohomolets National Medical University. The treatment was carried out in 2 stages. In the main group (n = 60), the first stage of treatment included the intragastric balloon placement for a term of 6 months. The control group (n = 37) received a six‑month conservative therapy. In the second stage of treatment the patients of both groups underwent a surgical procedure for the morbid obesity management. Results. The outcomes of the first stage of treatment showed that the patients, who underwent the intragastric balloon placement, had statistically significantly (p < 0.001) higher mean the percentage of excess weight loss (% EWL) than the patients who received conservative therapy. In the main group, the average ASA PS score, which is identified as an anaesthetic and surgical risk indicator, decreased from 3.28 (95 % confidence interval (CI) 3.17 — 3.40) to 2.15 (95 % CI 2.06 — 2.24, p < 0.001), and in the control group — from 3.24 (95 % CI 3.10 — 3.39) to 3.14 (95 % CI 2.96 — 3.31, p > 0.05). Conclusions. The results of the study provide strong evidence that the intragastric balloon placement for a term of 6 months reduces surgical and anaesthetic risks, contributes to the improved function of the cardiovascular and respiratory systems as well as gives a boost to carbohydrate metabolism, and, therefore, can be suggested for the preparation of super obese patients with high risk of surgical and anaesthesia‑related complications for bariatric surgery.