Aminian Ali, Andalib Amin, Ver Maria R, Corcelles Ricard, Schauer Philip R, Brethauer Stacy A
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
Obes Surg. 2016 Jun;26(6):1186-90. doi: 10.1007/s11695-015-1909-y.
Obesity has become prevalent in patients with inflammatory bowel disease (IBD). Bariatric surgery can be considered to be contraindicated in IBD patients. We aimed to evaluate feasibility, safety, and efficacy of bariatric surgery in IBD patients.
We retrospectively identified all morbidly obese patients with a known diagnosis of IBD, who underwent bariatric surgery between January 2005 and December 2012. Postoperative outcomes and status of IBD in patients on maintenance therapy for their disease were assessed.
We identified 20 IBD patients including 13 ulcerative colitis (UC) and 7 Crohn's disease (CD) patients with a mean age of 54.0 ± 10.5 years, BMI of 50.1 ± 9.0 kg/m(2), and duration of IBD of 11.3 ± 5.2 years. Eleven patients were on medication for IBD at baseline. Bariatric procedures included sleeve gastrectomy (N = 9), gastric bypass (N = 7), gastric banding (N = 3), and one conversion of band to gastric bypass. There were no intraoperative complications, but two conversions to laparotomy due to adhesions. Mean BMI change and excess weight loss at 1 year was 14.3 ± 5.7 kg/m(2) and 58.9 ± 21.1 %, respectively. Seven early postoperative complications occurred including dehydration (N = 5), pulmonary embolism (N = 1), and wound infection (N = 1). During a mean follow-up of 34.6 ± 21.7 months, five patients developed complications including pancreatitis (N = 2), ventral hernia (N = 2), and marginal ulcer (N = 1). Nine out of ten eligible patients experienced improvement in their IBD status.
Bariatric surgery is feasible and safe in morbidly obese patients suffering from IBD. In addition to being an effective weight loss procedure, bariatric surgery may help mitigate symptoms in this patient population.
肥胖在炎症性肠病（IBD）患者中已变得普遍。减重手术在IBD患者中可被视为禁忌。我们旨在评估减重手术在IBD患者中的可行性、安全性和疗效。
我们回顾性地确定了所有在2005年1月至2012年12月期间接受减重手术且已知诊断为IBD的病态肥胖患者。评估了接受疾病维持治疗患者的术后结局和IBD状况。
我们确定了20例IBD患者，其中包括13例溃疡性结肠炎（UC）患者和7例克罗恩病（CD）患者，平均年龄为54.0±10.5岁，体重指数（BMI）为50.1±9.0kg/m²，IBD病程为11.3±5.2年。11例患者在基线时接受IBD药物治疗。减重手术方式包括袖状胃切除术（n = 9）、胃旁路术（n = 7）、胃束带术（n = 3）以及1例从束带术转为胃旁路术。术中无并发症，但有2例因粘连转为开腹手术。1年时平均BMI变化和超重减轻分别为14.3±5.7kg/m²和58.9±21.1%。术后早期发生了7例并发症，包括脱水（n = 5）、肺栓塞（n = 1）和伤口感染（n = 1）。在平均34.6±21.7个月的随访期间，5例患者出现并发症，包括胰腺炎（n = 2）、腹疝（n = 2）和边缘溃疡（n = 1）。10例符合条件的患者中有9例IBD状况得到改善。
减重手术在患有IBD的病态肥胖患者中是可行且安全的。除了是一种有效的减重手术外，减重手术可能有助于减轻该患者群体的症状。
