Background: Prader-Willi syndrome (PWS) is the most common genetic obesity.
Excessive weight gain follows failure-to-thrive in early infancy; in adole
scents and young adults, excess body weight can exceed 100%. The hyperphagi
a associated with PWS is responsible for the early mortality. Dietary restr
iction, alone or combined with anorexic drugs, are ineffective to induce a
permanent weight loss. Thus, surgical treatment of morbid obesity in PWS ha
s been attempted, but gastric restrictive operations are unable to produce
stable weight loss. In a small number of patients, favorable results have b
een reported with biliopancreatic diversion (BPD).
Case Report: A 24-year-old woman with PWS, Pickwickian, at age 21 weighed 8
0 kg (BMI = 50) and underwent BPD.
Results: 3 years after the BPD she regained 21 of the 26 kg lost; somnolenc
e and respiratory difficulties were the same as before surgery. The patient
now presents severe reduction of bone mass density, hypochromic anemia, hy
poproteinemia, and diarrhea associated with eating.
Conclusion: The regain of weight following BPD suggests that this procedure
alone is not adequate for long-term control of obesity in PWS.