Impact of weight reduction surgery on static and dynamic lung volumes

BACKGROUND

Obesity could affect many functions of the body systems, particularly respiratory system. Effect of obesity on respiratory system leads to an impairment in pulmonary function tests which is represented by a decrease in lung volumes and capacities, therefore obstructive or restrictive pulmonary diseases may develop. The recent study was conducted to investigate and assess the impact of weight loss by surgery on static and dynamic lung volumes (pulmonary function tests) and the improvement in co morbidities.

PATIENTS AND METHODS

The study included 68 morbid obese patients, 36 females and 32 males. The patients were with age range 24-56 years, BMI≥ 40 kg/m2or≥35 kg/m2 with co morbidities. Pulmonary volumes and function tests of all patients were measured before weight loss surgery and one year after the surgery.

RESULT

The results showed a significant reduction in the body weight (p < 0.05), with an improvement in co morbidities. Pulmonary volumes ERV,IRV,TLC, FRC and RV were significantly changed one year after surgery as well as there were significant increases in the mean values of the dynamic volumes such as FEV1,FEV1%,FEF50%, PEF and MVV.(p < 0.05).

CONCLUSION

loss of excess body weight by bariatric surgery resulted in a significant improvement in co morbidities and function of respiratory system represented by significant changes in both static and dynamic lung volumes ….

Delayed presentation of iatrogenic ventriculoperitoneal shunt transection following laparoscopic weight loss surgery in a patient with idiopathic intracranial hypertension

Idiopathic intracranial hypertension is strongly associated with central obesity and consequential raised intra-abdominal pressure. If left untreated it poses significant risk to vision and can eventually cause blindness. Owing to its pathophysiology, this condition is managed by both medical and surgical specialities. When medical management fails neurosurgeons commonly treat idiopathic intracranial hypertension by permanent cerebrospinal fluid peritoneal shunting. Weight reduction surgery provides patients who are obese with a multitude of benefits and it is not uncommon for the general surgeon to be presented with a patient with idiopathic intracranial hypertension and a cerebrospinal fluid peritoneal shunt in place. This provides a potential challenging situation in weight-loss surgical procedures. We describe an interesting case where laparoscopic bariatric surgery resulted in transection of the abdominal catheter with a delayed presentation of recurrent symptoms and an abdominal cerebrospinal fluid collection in a patient with idiopathic intracranial hypertension. We discuss how this could be avoided and its management.

Liver transplantation and sleeve gastrectomy in the medically complicated obese: New challenges on the horizon

In the last 30 years, operative, technical and medical advances have made liver transplantation (LT) a life-saving therapy that is used worldwide today. Global industrialization has been a contributor to morbid obesity and this has brought about the metabolic syndrome along with many downstream complications of such. Non-alcoholic steatohepatitis (NASH) has become a recognized hepatic manifestation of the metabolic syndrome and NASH cirrhosis is predicted to be the primary indication for LT in the United States by 2025. Several case series and database reviews have begun analyzing the efficacy of weight reduction surgery in the LT recipient. These data have reasonably demonstrated that weight reduction surgery in the LT recipient is a feasible endeavor. However, several questions have been raised regarding the type of weight reduction surgery, timing of surgery in relation to LT, patient and allograft survival and post-LT maintenance of weight loss to name a few. We look forward to a time when weight reduction surgery will work to improve the technical conduct of LT, improve perioperative benchmarks such as blood transfusions, intensive care unit length of stay and help to prevent recurrence of NASH cirrhosis in the medically complicated obese patient. In the meantime, well-designed prospective clinical trials that focus on the issues highlighted will help guide us in the care of these complicated patients who will soon account for the majority of the patients in our clinics.