Effect of immunosuppression on patients undergoing bariatric surgery

Background: Immunocompromised patients tire at high risk of medical complications. Immunosuppression might be a relative contraindication to bariatric surgery. WC describe our experience with immunosuppressed patients undergoing bariatric surgery and review the safety, efficacy, results and outcomes. Methods: We performed I retrospective review of prospectively collected data. All patients taking, long-term immunosuppressive medications or with a diagnosis of an immunosuppressive condition were included in this study. Data on weight loss, co-morbidites, complications, and postoperative immunosuppression were collected. Results: From July 1999 to February 2008. 1566 patients underwent bariatric surgery. Of these 1566 patients, 61 (3.9%) were taking medications or had an immunosuppressive condition. Of these 61 patients, 49 were taking immunosuppressive medications for asthma. autoimmune disorders, endocrine deficiency, or chronic inflammatory disorders. The medications included oral, inhaled, and topical glucocorticoids for 39 patients and other immunosuppression or disease-modifying antirheumatic drugs for 24 patients. The bariatric procedures included laparoscopic Roux-en-Y gastric bypass in 55, laparoscopic revisional procedures in 5 and laparoscopic sleeve gastrectomy in 1. No patient died periopertitively. A total of 26 complications occured in 20 patients. The average percentage of excess weight loss was 72% (range 20-109%) at 1 year postoperatively. At a median postoperative follow-up of 18 months (range 2-68.6%), 25(51%) of 49 patients 110 longer required immunosuppressive medications owing to improvement of their underlying disease. Obesity-related health poblems (diabetes mellitus. hypertension. obstructive sleep apnea, gastroesophaged reflux disease, asthma) had resolved or improved in 80-100% of patients. Conclusion: The results of our study have shown that immunocompromised patients can safely undergo bariatric surgery with good weight loss results and improvement in co-morbidities. A large percentage of patients were bale to discrimintate immunosuppressive medications postoperativerly (Surg Obcs Relat Dis 2009:5:339-345.) (C) 2009 American Society for Metabolic and Bariatric Surgery. All rights reserved.