IMPACT OF VERTICAL BANDED GASTROPLASTY ON RESPIRATORY INSUFFICIENCY OF SEVERE OBESITY

Background: Respiratory insufficiency associated with morbid obesity c an include sleep apnea syndrome (SAS), obesity hypoventilation syndrom e (OHS), or a combination of both. The aim of our study was to determi ne the safety and effectiveness of vertical banded gastroplasty (VBG) in the treatment of severely obese patients with respiratory insuffici ency. Methods: From 1983 to 1994, 35 patients (25 males, ten females) who met the criteria for either SAS and OHS (19 patients) or SAS alone (16 patients) underwent VBG. Results: Six patients (17%) died of subs equent pulmonary-cardiac disease despite significant weight loss. Need for nasal continuous positive airway pressure (CPAP) decreased after VBG from 68% of patients preoperatively to 22% postoperatively. Of the ten patients with sleep studies, the apnea/hyponea index decreased fr om 45 +/- 11 events per h preoperatively to 12 +/- 6 events per h post operatively, while per cent ideal body weight (%IBW) also decreased (p re-VBG: 268 +/- 12, post-VBG: 204 +/- 12). Of the seven patients with arterial blood gases, PaCO2 decreased from 55 +/- 4 torr preoperativel y to 41 +/- 3 torr postoperatively, and PaO2 increased from 50 +/- 4 t orr preoperatively to 73 +/- 6 torr postoperatively, while %IBW decrea sed (pre-VBG: 263 +/- 16, post-VBG: 193 +/- 14). Conclusion: Respirato ry insufficiency is a life-threatening complication of morbid obesity. In morbidly obese patients with respiratory insufficiency, VBG offers improvement in both SAS and OHS. Respiratory insufficiency due to obe sity should be considered a strong indication for VBG.