Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Ave/A100, Cleveland, OH, 44195, USA.
Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia.
Surg Endosc. 2019 Jun;33(6):1952-1958. doi: 10.1007/s00464-018-6475-7. Epub 2018 Oct 26.
Perioperative pulmonary complications are frequent in patients with interstitial lung diseases (ILD). Limited literature exists regarding the safety of bariatric procedures in patients with ILD. This study aims to assess the safety, feasibility, and outcomes of patients with ILD who underwent bariatric surgery at our institution.
After IRB approval, all patients with preoperative diagnosis of ILD who had bariatric surgery at an academic center between 2004 and 2014 were retrospectively reviewed.
A total of 25 patients with ILD underwent bariatric surgery: Roux-en-Y gastric bypass (n = 17, 68%), sleeve gastrectomy (n = 7, 28%), and adjustable gastric banding (n = 1, 4%). Twenty-one patients (84%) were females. The median age and preoperative body mass index (BMI) were 53 (IQR 42-58) years and 39 (IQR 37-44) kg/m, respectively. The median operative time and length of stay was 137 (IQR 110-187) min and 3 (IQR 2-5) days, respectively. The 30-day complications were reported in four patients (16%) but there was no pulmonary complication or unplanned admission to the intensive care unit. At 1-year follow-up (85%), the median BMI and excess weight loss were 30 (IQR 25-36) kg/m and 67% (IQR 45-100), respectively. Compared to preoperative values, there was significant improvement in the pulmonary function test (PFT) variables at 1 year with respect to forced vital capacity (62% vs 74%; n = 13, p = 0.003), and diffusing capacity of the lungs for carbon monoxide (53% vs 66%; n = 10, p = 0.003). Six out of the seven potential lung transplant candidates became eligible for transplantation after weight loss, and one of them had successful lung transplant at 88 months after bariatric surgery.
In our experience, bariatric patients with ILD achieved significant weight loss and improvement in PFT. Bariatric surgery in these higher risk ILD patients appears relatively safe with acceptable perioperative morbidity and improved candidacy for lung transplantation.
围手术期肺部并发症在患有间质性肺疾病（ILD）的患者中很常见。关于ILD 患者行减重手术的安全性，相关文献有限。本研究旨在评估我院行减重手术的 ILD 患者的安全性、可行性和结局。
在获得机构审查委员会批准后，回顾性分析了 2004 年至 2014 年间在学术中心行减重手术且术前诊断为 ILD 的所有患者。
共有 25 例 ILD 患者接受了减重手术：胃旁路术（n=17，68%）、袖状胃切除术（n=7，28%）和可调胃束带术（n=1，4%）。21 例（84%）患者为女性。中位年龄和术前体重指数（BMI）分别为 53（四分位距 42-58）岁和 39（四分位距 37-44）kg/m2。中位手术时间和住院时间分别为 137（四分位距 110-187）min 和 3（四分位距 2-5）d。4 例（16%）患者报告了 30 天并发症，但无肺部并发症或计划外入住重症监护病房。在 1 年随访（85%）时，中位 BMI 和多余体重减轻分别为 30（四分位距 25-36）kg/m2 和 67%（四分位距 45-100）。与术前值相比，1 年时用力肺活量（62%比 74%；n=13，p=0.003）和一氧化碳弥散量（53%比 66%；n=10，p=0.003）等肺功能检查（PFT）变量有显著改善。在体重减轻后，7 名潜在肺移植候选者中有 6 名符合肺移植标准，其中 1 名在减重手术后 88 个月成功进行了肺移植。
根据我们的经验，ILD 患者接受减重手术后体重显著减轻，PFT 改善。在这些高风险 ILD 患者中，减重手术相对安全，围手术期发病率可接受，并且肺移植的候选资格得到改善。
