Khasnabish Srijesa, Irving Dondre, Nahidi Seyed Mohammad, Engler Christopher, Ahmed Leaque
Internal Medicine, New York Institute of Technology College of Osteopathic Medicine, New York, USA.
Surgery, Wyckoff Heights Medical Center, Brooklyn, USA.
Cureus. 2023 Feb 14;15(2):e34966. doi: 10.7759/cureus.34966. eCollection 2023 Feb.
Obesity, defined as body mass index (BMI) > 30 kg/m, complicates maternal and neonatal outcomes. Bariatric surgery (BS) is an option for weight reduction in several populations, including reproductive-aged women. However, there is a lack of consensus regarding the ideal time interval between BS and pregnancy. We report the case of a 43-year-old Hispanic female who underwent an initial Roux-en-Y gastric bypass (RYGB) in 2011, followed by a revision eight years later in 2019. The revision entailed the reduction of the gastric pouch size and the excision of the remnant stomach. It occurred sixteen months before the conception of her second pregnancy. Despite advanced maternal age and nutritional challenges following BS, this patient delivered a healthy male neonate and maintained a net weight loss compared to her preoperative weight. Factors leading to this positive outcome included the patient's adherence to dietary recommendations following the procedure and using weight loss adjuncts (phentermine and topiramate) to promote post-procedure weight loss. Sixteen months between RYGB revision and conception can lead to positive pregnancy outcomes, even in women of advanced maternal age and multiple prior BS. Further studies are required to understand better the optimal interval to reduce maternal and neonatal complications following RYGB specifically and the use of medications as weight loss adjuncts.
肥胖定义为体重指数（BMI）>30kg/m²，会使孕产妇和新生儿结局复杂化。减肥手术（BS）是包括育龄妇女在内的几类人群减轻体重的一种选择。然而，关于减肥手术后与怀孕之间的理想时间间隔，目前尚无共识。我们报告了一例43岁西班牙裔女性的病例，她于2011年首次接受了Roux-en-Y胃旁路术（RYGB），八年后的2019年进行了翻修手术。翻修手术包括缩小胃囊大小和切除残余胃。该手术在她第二次怀孕前16个月进行。尽管产妇年龄较大且减肥手术后存在营养方面的挑战，但该患者产下了一名健康的男婴，并且与术前体重相比保持了净体重减轻。导致这一积极结果的因素包括患者在手术后坚持饮食建议，并使用减肥辅助药物（芬特明和托吡酯）来促进术后体重减轻。RYGB翻修手术与怀孕间隔16个月可带来积极的妊娠结局，即使是高龄产妇且之前接受过多次减肥手术。还需要进一步研究，以更好地了解具体减少RYGB术后孕产妇和新生儿并发症的最佳间隔时间，以及使用药物作为减肥辅助药物的情况。
