OBJECTIVE: To determine the risks and benefits of
gastric bypass-induced
weight loss on severe
venous stasis disease in
morbid obesity. SUMMARY BACKGROUND DATA:
Severe obesity is associated with a risk of lower extremity
venous stasis disease, pretibial ulceration,
cellulitis, and
bronze edema. METHODS: The GBP database was queried for
venous stasis disease including pretibial
venous stasis ulcers,
bronze edema, and
cellulitis. RESULTS: Of 1,976 patients undergoing GBP, 64 (45% female) met the criteria.
Mean age was 44 +/- 10 years. Thirty-seven patients had pretibial
venous stasis ulcers, 4 had
bronze edema, 23 had both, and 17 had recurrent
cellulitis. All had 2 to 4+
pitting pretibial edema.
Mean preoperative
body mass index (BMI) was 61 +/- 12 kg/m(2) and weight was 179 +/- 39 kg (270 +/- 51% ideal
body weight), significantly greater than in patients who underwent GBP without
venous stasis disease. Two patients had a
pulmonary embolus and four had
Greenfield filters in the remote past. Additional
comorbidities included
obesity hypoventilation syndrome,
sleep apnea syndrome,
hypertension,
gastroesophageal reflux,
degenerative joint disease symptoms,
type 2 diabetes mellitus,
pseudotumor cerebri, and
urinary incontinence.
Comorbidities were significantly more frequent in the patients with
venous stasis disease than for those without. At 3.9 +/- 4 years after
surgery, patients lost 55 +/- 21 % of excess weight, 62 +/- 33 kg, reaching 40 +/- 9 kg/m(2) BMI or 176 +/- 41% ideal
body weight.
Venous stasis ulcers resolved in all but three patients. Complications included
anastomotic leaks with
peritonitis and death, fatal
pulmonary embolism, fatal
respiratory arrest,
wound infections or
seromas, staple line disruptions, marginal ulcerations treated with acid suppression, stomal stenoses treated with
endoscopic dilatation, late
small bowel obstructions, and incisional
hernias. There were six other late deaths. CONCLUSIONS: Severe
venous stasis disease was associated with a significantly greater weight, BMI, male sex, age,
comorbidity, and
surgical risk (
pulmonary embolus,
leak, death, incisional
hernia) than in other patients who underwent GBP.
Surgically induced
weight loss corrected the
venous stasis disease in almost all patients as well as their other obesity-related problems.
