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. 1981 Jun;193(6):677–685. doi: 10.1097/00000658-198106000-00002

Gastroplasty for respiratory insufficiency of obesity.

H J Sugerman, R P Fairman, A K Lindeman, J A Mathers, L J Greenfield
PMCID: PMC1345150  PMID: 6788002

Abstract

Three patients with the obesity hypoventilation syndrome and one patient with the sleep apnea syndrome underwent gastroplasty for weight reduction. A tracheostomy was also performed in the patient with sleep apnea. The PaO2 rose from an average of 51 +/- 9 to 71 +/- 5 torr and the PaCO2 fell from an average of 51 +/- 21 to 41 +/- 6 torr within two to ten months following bariatric surgery. The improved arterial blood gases were associated with an increased forced vital capacity in each patient. The change in maximum voluntary ventilation was variable. Sleep capneography demonstrated cure of the patient with sleep apnea permitting removal of the tracheostomy. All four patients have returned to productive lives in society. Given proper pre- and postoperative care, patients with respiratory insufficiency tolerate the operation well. Respiratory insufficiency associated with morbid obesity should be considered an indication for the gastroplasty procedure, rather than a contraindication as previously suggested.

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Selected References

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  1. Alden J. F. Gastric and jejunoileal bypass. A comparison in the treatment of morbid obesity. Arch Surg. 1977 Jul;112(7):799–806. doi: 10.1001/archsurg.1977.01370070011001. [DOI] [PubMed] [Google Scholar]
  2. BEDELL G. N., WILSON W. R., SEEBOHM P. M. Pulmonary function in obese persons. J Clin Invest. 1958 Jul;37(7):1049–1060. doi: 10.1172/JCI103686. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. BICKELMANN A. G., BURWELL C. S., ROBIN E. D., WHALEY R. D. Extreme obesity associated with alveolar hypoventilation; a Pickwickian syndrome. Am J Med. 1956 Nov;21(5):811–818. doi: 10.1016/0002-9343(56)90094-8. [DOI] [PubMed] [Google Scholar]
  4. Buckwalter J. A. A prospective comparison of the jejunoileal and gastric bypass operations for morbid obesity. World J Surg. 1977 Nov;1(6):757–768. doi: 10.1007/BF01555933. [DOI] [PubMed] [Google Scholar]
  5. Buckwalter J. A., Herbst C. A., Jr Complications of gastric bypass for morbid obesity. Am J Surg. 1980 Jan;139(1):55–60. doi: 10.1016/0002-9610(80)90230-5. [DOI] [PubMed] [Google Scholar]
  6. Chodoff P., Imbembo A. L., Knowles C. L., Margand P. M. Massive weight loss following jejunoileal bypass. I. Effects on pulmonary function. Surgery. 1977 Apr;81(4):399–403. [PubMed] [Google Scholar]
  7. Ellison E. C., Martin E. W., Jr, Laschinger J., Mojzisik C., Hughes K., Carey L. C., Pace W. G. Prevention of early failure of stapled gastric partitions in treatment of morbid obesity. Arch Surg. 1980 Apr;115(4):528–533. doi: 10.1001/archsurg.1980.01380040150027. [DOI] [PubMed] [Google Scholar]
  8. Freeman J. B., Burchett H. J. A comparison of gastric bypass and gastroplasty for morbid obesity. Surgery. 1980 Sep;88(3):433–444. [PubMed] [Google Scholar]
  9. Gomez C. A. Gastroplasty in the surgical treatment of morbid obesity. Am J Clin Nutr. 1980 Feb;33(2 Suppl):406–415. doi: 10.1093/ajcn/33.2.406. [DOI] [PubMed] [Google Scholar]
  10. Greenfield L. J., Scher L. A., Elkins R. C. KMA-Greenfield filter placement for chronic pulmonary hypertension. Ann Surg. 1979 May;189(5):560–565. doi: 10.1097/00000658-197905000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Griffen W. O., Jr, Young V. L., Stevenson C. C. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity. Ann Surg. 1977 Oct;186(4):500–509. doi: 10.1097/00000658-197710000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Guilleminault C., Tilkian A., Dement W. C. The sleep apnea syndromes. Annu Rev Med. 1976;27:465–484. doi: 10.1146/annurev.me.27.020176.002341. [DOI] [PubMed] [Google Scholar]
  13. Halverson J. D., Gentry K., Wise L., Ballinger W. F. Reanastomosis after jejunoileal bypass. Surgery. 1978 Aug;84(2):241–249. [PubMed] [Google Scholar]
  14. Halverson J. D., Wise L., Wazna M. F., Ballinger W. F. Jejunoileal bypass for morbid obesity. A critical appraisal. Am J Med. 1978 Mar;64(3):461–475. doi: 10.1016/0002-9343(78)90233-4. [DOI] [PubMed] [Google Scholar]
  15. Johnson D., Drenick E. J. Therapeutic fasting in morbid obesity. Arch Intern Med. 1977 Oct;137(10):1381–1382. [PubMed] [Google Scholar]
  16. Kronenberg R. S., Gabel R. A., Severinghaus J. W. Normal chemoreceptor function in obesity before and after ileal bypass surgery to force weight reduction. Am J Med. 1975 Sep;59(3):349–353. doi: 10.1016/0002-9343(75)90393-9. [DOI] [PubMed] [Google Scholar]
  17. Kryger M., Quesney L. F., Holder D., Gloor P., MacLeod P. The sleep deprivation syndrome of the obese patient. A problem of periodic nocturnal upper airway obstruction. Am J Med. 1974 Apr;56(4):530–539. doi: 10.1016/0002-9343(74)90485-9. [DOI] [PubMed] [Google Scholar]
  18. Luce J. M. Respiratory complications of obesity. Chest. 1980 Oct;78(4):626–631. doi: 10.1378/chest.78.4.626. [DOI] [PubMed] [Google Scholar]
  19. Mason E. E., Ito C. Gastric bypass in obesity. Surg Clin North Am. 1967 Dec;47(6):1345–1351. doi: 10.1016/s0039-6109(16)38384-0. [DOI] [PubMed] [Google Scholar]
  20. Mason E. E., Printen K. J., Barron P., Lewis J. W., Kealey G. P., Blommers T. J. Risk reduction in gastric operations for obesity. Ann Surg. 1979 Aug;190(2):158–165. doi: 10.1097/00000658-197908000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Mason E. E., Printen K. J., Blommers T. J., Lewis J. W., Scott D. H. Gastric bypass in morbid obesity. Am J Clin Nutr. 1980 Feb;33(2 Suppl):395–405. doi: 10.1093/milmed/146.2.91. [DOI] [PubMed] [Google Scholar]
  22. Pace W. G., Martin E. W., Jr, Tetirick T., Fabri P. J., Carey L. C. Gastric partitioning for morbid obesity. Ann Surg. 1979 Sep;190(3):392–400. doi: 10.1097/00000658-197909000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Paul D. R., Hoyt J. L., Boutros A. R. Cardiovascular and respiratory changes in response to change of posture in the very obese. Anesthesiology. 1976 Jul;45(1):73–78. doi: 10.1097/00000542-197607000-00013. [DOI] [PubMed] [Google Scholar]
  24. Peltier G., Hermreck A. S., Moffat R. E., Hardin C. A., Jewell W. R. Complications following gastric bypass procedures for morbid obesity. Surgery. 1979 Oct;86(4):648–654. [PubMed] [Google Scholar]
  25. Ravitch M. M., Brolin R. E. The price of weight loss by jejunoileal shunt. Ann Surg. 1979 Sep;190(3):382–391. doi: 10.1097/00000658-197909000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Rochester D. F., Enson Y. Current concepts in the pathogenesis of the obesity-hypoventilation syndrome. Mechanical and circulatory factors. Am J Med. 1974 Sep;57(3):402–420. doi: 10.1016/0002-9343(74)90135-1. [DOI] [PubMed] [Google Scholar]
  27. Santesson J., Nordenström J. Pulmonary function in extreme obesity. Influence of weight loss following intestinal shunt operation. Acta Chir Scand Suppl. 1978;482:36–40. [PubMed] [Google Scholar]
  28. Sixt R., Bake B., Kral J. Closing volume and gas exchange in obese patients before and after intestinal bypass operation. (A preliminary report). Scand J Respir Dis Suppl. 1976;95:65–72. [PubMed] [Google Scholar]
  29. Soterakis J., Glennon J. A., Ishihara A. M., Tyler J. M., Iber F. L. Pulmonary function studies before and after jejunoileal bypass surgery. Am J Dig Dis. 1976 Jul;21(7):553–556. doi: 10.1007/BF01464762. [DOI] [PubMed] [Google Scholar]
  30. Stalnecker M. C., Suratt P. M., Chandler J. G. Changes in respiratory function following small bowel bypass for obesity. Surgery. 1980 Jun;87(6):645–651. [PubMed] [Google Scholar]
  31. Söderberg M., Thomson D., White T. Respiration, circulation and anaesthetic management in obesity. Investigation before and after jejunoileal bypass. Acta Anaesthesiol Scand. 1977;21(1):55–61. doi: 10.1111/j.1399-6576.1977.tb01194.x. [DOI] [PubMed] [Google Scholar]
  32. Vaughan R. W., Bauer S., Wise L. Effect of position (semirecumbent versus supine) on postoperative oxygenation in markedly obese subjects. Anesth Analg. 1976 Jan-Feb;55(1):37–41. [PubMed] [Google Scholar]

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