Risks and benefits of gastric bypass in morbidly obese patients with severe venous stasis disease

Objective To determine the risks and benefits of gastric bypass-induced weight loss o n severe venous stasis disease in morbid obesity. Summary Background Data Severe obesity is associated with a risk of lower extremity venous stasis d isease, 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 s tasis ulcers, 4 had bronze edema, 23 had both. and 17 had recurrent celluli tis. Ail had 2 to 4+ pitting pretibial edema. Mean preoperative body mass i ndex (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 GB P without venous stasis disease. Two patients had a pulmonary embolus and f our had Greenfield filters in the remote past. Additional comorbidities inc luded obesity hypoventilation syndrome, sleep apnea syndrome, hypertension, gastroesophageal reflux, degenerative joint disease symptoms, type 2 diabe tes 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 1 76 +/- 41% ideal body weight. Venous stasis ulcers resolved in ail but thre e patients. Complications included anastomotic leaks with peritonitis and d eath, 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 smal l bowel obstructions, and incisional hernias. There were six other late dea ths. Conclusions Severe venous stasis disease was associated with a significantly greater we ight, 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 almo st ail patients as well as their other obesity-related problems.