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Laparoscopic Bariatric Surgery Is Safe in Patients With Mild to Moderate Pulmonary Hypertension
Hernan Urrego*, William S. Richardson, James Wooldridge
General Surgery, Ochsner Clinical Foundation, New Orleans, LA
Background:
Pulmonary hypertension (PH) has significant perioperative risks that may outweigh the benefit of elective surgery. There is very little data on laprascopic surgery in the setting of PH. Our objective was to look at our outcomes of bariatric surgery in patients with PH.
Methods:
A retrospective review of a prospectively gathered database of all bariatric procedures was conducted for patients treated from 2007-2011. All patients with PH who underwent a bariatric procedure were reviewed for their preoperative evaluation, intra-operative monitoring and management, post-operative care, and clinic follow up.
Results:
809 bariatric procedures were performed from 2007-2011, 5 patients (0.6%), 3 males and 2 females, had PH. 2 patients had Type 1 PH, 2 had Type III PH, and the final patient did not have information on the etiology. The mean PAP of the 5 patients was 40 mmHG (range 25-60). The mean age of the patients was 58 years of age, and the mean BMI was 52. 3 laparoscopic Roux-N-Y, 1 laparoscopic sleeve gastrectomy, and 1 laparoscopic band were performed. Invasive monitoring, arterial line and/or pulmonary catheter, was used in 2 patients with mean PAP ≥ 40. There were no intra-operative complications and only one patient had a long term complication; band slipped and underwent removal. The mean length of stay was 2 days and mean follow up was 8 months. Mean excess body weight loss (EBL) at 3 months was 29% (N=5), at 6 months was 42% (N=4), and at 1 year 35% (N=2). Over an average of 6 months, exercise tolerance in all 3 Roux-N-Y patients was doubled in terms of length of exercise time and distance walking, and remained the same in the other two. Postoperative pulmonary hypertension follow up with 2d echo was only performed in one patient. A decrease of mean PAP from 39 to 26, 1 year after surgery, without concomitant change in medical therapy was demonstrated.
Conclusions:
Laparoscopic surgery seems safe in patients with pulmonary hypertension without significant morbidity, mortality or increased length of stay. Invasive monitoring in patients with mean PAP > 25mmHG<40mmHG may not be necessary. Exercise tolerance improves in most patients. EBL was modest but few patients had 1 year follow up. Further research is needed to determine long term weight loss, improvement in comorbidities and improvement in PH.
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