Challenges and outcomes for bariatric surgery in patients with paraplegia: Case series and systematic review

Research output: Contribution to journalArticlepeer-review

Authors

  • Georgia R. Layton
  • Shivam Bhanderi
  • Mohamed Sahloul
  • Vasileios Charalampakis
  • Markos Daskalakis

Colleges, School and Institutes

External organisations

  • Leicester General Hospital, University Hospitals Leicester NHS Trust Leicester UK
  • Warwick Hospital, South Warwickshire NHS Foundation Trust Warwick UK

Abstract

Introduction
Obesity contributes to a plethora of significant chronic diseases. Bariatric surgery has been demonstrated to be the most cost‐effective treatment for severe obesity and significantly reduces morbidity and mortality from metabolic syndrome.

Patients with paraplegia have significantly impaired mobility and are therefore at a much higher risk of developing severe obesity and its sequelae. Bariatric surgery may bring significant improvements to mobility, morbidity and quality of life for patients with paraplegia, but evidence in the literature is poor for this group of patients.

Methods
A systematic review was conducted conforming to PRISMA guidelines. The MEDLINE and Cochrane databases were searched for all articles published prior to April 2019 matching all of the keywords ‘bariatric’, ‘paraplegia’ and ‘spinal cord’. Articles were assessed for relevance and full texts reviewed.

In addition, clinical records were reviewed for three patients who underwent bariatric surgery at a single UK private institution. Non‐identifiable demographic, clinical, operative and outcome data were obtained from electronic records.

Results
Twenty seven articles were retrieved from the initial database search, of which nine eligible full texts were reviewed. Eight articles were case reports or case series and the final article was a systematic review. All cases reported had positive outcomes with significant weight loss, improvement in mobility and increased quality of life. Outcomes from the three diversely aged patients in our case series were similarly positive, with no significant post‐operative complications.

Discussion
Patients with obesity and paraplegia may significantly benefit from bariatric surgery. There is a need for multi‐centre cohort studies to evaluate outcomes and the choice of bariatric intervention. UK guidelines do not include criteria based on mobility or neurological deficit, resulting in a potential missed opportunity to offer a cost‐effective treatment that can significantly improve quality of life for patients with severe obesity and paraplegia.

Details

Original languageEnglish
Article numbere12382
JournalClinical Obesity
Volume10
Issue number4
Early online date7 Jun 2020
Publication statusPublished - 1 Aug 2020

Keywords

  • bariatric surgery, gastric bypass, obesity surgery, paraplegia, sleeve gastrectomy