Safety & Efficacy Of Intra-Gastric Balloon as bridging to bariatric surgery in supersuper morbid obese & high risk candidates

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Obesity is a disease in which fat has accumulated to the extent that HEALTH is IMPAIRED.

It is a complex, multifactorial disease that results from the interaction of genetic and environmental factors.

No disease is more common and causes more unnecessary illness or premature death than obesity.

Furthermore, there is no other single problem that so reduces the quality of life by limiting physical activity and encouraging social isolation, or increases the demand for health care services.

With time and greatest economic evolution, Obesity is rapidly becoming one of the greatest health challenges of the 21st century.

Although, Bariatric surgery is the best long-term treatment for morbid obesity,
however, it carries risks of considerable morbidity and potential mortality.

Obese patients are at a greater risk of developing postoperative pulmonary complications as well as wound infections, DVT, and cardiac events compared to non-obese patients.

Super-obesity considered when BMI more than 50 kg/m2, and related to higher incidences of comorbidities, major technical difficulties, increased risks of surgical and anesthetic
complications and higher incidences of peri- and postoperative adversities.

Careful preoperative assessment and optimization can help to minimize these complications and adversities.

Weight loss before surgery can be one of theses important measures and strategies to decrease perioperative morbidity and mortality.

Furthermore, patients who are able to achieve 10% EBWL preoperatively have shorter hospitalization and more rapid weight loss.

The most common strategies for preoperative weight loss are a very low caloric diet, drug treatment, anintragastric balloon and hospitalization for strict diet supervision.

Preoperative very-low-calorie diet for 6 weeks has been shown toreduce liver volume by 20% and to improve access to the upper stomach during laparoscopic surgery, with 80% of the

volume change occurring in the first 2 weeks.

Furthermore, patients who are able to achieve 10% EBWL preoperatively have shorter hospitalization and more rapid weight loss.

Use of intra-gastric balloon as bridging for bariatric surgery in super-super morbidly(BMI > 60) has been studied in several reports in RYGBP, which showed good results and safety profile.

At king Abdullah Medical city- Makkah, we studied 45 super-super morbidly obese patients underwent IGB insertion as bridging prior to bariatric surgery.

In our study, IGB use bridging in supersuper morbid obese patients shows great efficacy and safety profile, with no major complications and minimal minor complications (< 10%).

 

IN CONCLUSION:
Preoperative weight loss before laparoscopic bariatric surgery in super morbid obese individuals is associated with a decrease in the operating room time and an improved percentage of excess weight loss in the short term, and might contribute to decrease in peri-operative morbidity.

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