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Multiple sclerosis and surgery

Bariatric surgery relatively safe and effective for MS patients

On average, MS patients who underwent bariatric surgery were walking 1.96 seconds faster than their nonsurgical cohort

Bariatric surgery is relatively safe and appears to be effective in patients with multiple sclerosis (MS), according to a study by researchers from Cleveland Clinic, Cleveland, OH. This study is thought to be the first retrospective case-control series evaluating the long-term surgical and ambulatory outcomes of bariatric surgery in MS patients. The paper, ‘Outcomes of Bariatric Surgery in Morbidly Obese Patients with Multiple Sclerosis’, was published in the Journal of Obesity.

The researchers retrospectively reviewed a database of 2,918 patients and found 22 (0.75%) severely obese patients with MS who underwent bariatric surgery. Twenty patients were female and two were male with a mean age of 45.7±9.6 years (range 32–62 years). The mean BMI was 46.5+7.2 (range 35.1–64.3). Sixteen surgical patients with complete follow-up data were matched to a non-surgical control group of MS patients, based on age, BMI, MS subtype, and length of follow-up.

Nineteen patients underwent laparoscopic Roux-en-Y gastric bypass (RYGB) and three patients underwent laparoscopic sleeve gastrectomy. One of the patients previously had a laparoscopic adjustable gastric band placed and subsequently underwent conversion to a RYGB.

Outcomes

The mean length of hospital stay was 4.4±4.2 days (range 2–23 days). One patient required a hospital stay of 23 days due to complications of an anastomotic leak at the jejunojejunostomy, and five patients required early readmission (one patient was readmitted for dehydration, one for a port site infection, one for an anastomotic ulcer, and one for a stricture managed with balloon dilation). One patient required re-operation two weeks following RYGB for an adhesive obstruction at the distal ileum related to a prior hysterectomy.

At last follow-up (mean =59.0±29.8 months) the mean percentage of excess weight loss was 75.5%±27.0, and percentage of total weight loss was 31.5%±11.8.

Pre- and post-operative T25FW data were available for 16 of the 22 patients who had bariatric surgery. The mean time frame between the two index visits was 41.2 months for the study sample and 39.8 months for the control group. For the surgical group, 11 patients (68.7%) showed no change in their walking speed, four patients (25%) exhibited improvement, and one patient experienced slowing.

In contrast, from the 16 patients comprising the control sample eight (50%) had slowing on serial testing, seven (44%) showed no change and one patient exhibited improvement. On average, MS patients who underwent bariatric surgery were walking 1.96 seconds faster than their nonsurgical cohort.

As for the quality of life measures, EQ-5D and PHQ-9 scores had improved on repeat assessment in both groups, with a nonsignificant difference between the two samples. Furthermore, the number of acute MS exacerbations during the follow-up period was four in the control group as compared to only two in the surgical group.

The investigators noted that the immune modulators used in this patient population do not seem to pose significant added risk, despite been associated with an elevated risk of postoperative complications. The researchers also acknowledged that their study was limited by the small sample size.

“Taken together, these data illustrate an overall acceptable safety profile of bariatric surgery in this patient population. In addition, we did not observe disease worsening or increased relapses following bariatric surgery,” the authors conclude. “While the observational nature of this study precludes definitive conclusions, the results are encouraging. Our data suggest that bariatric surgery is a viable treatment option for the severely obese MS patient and that the surgical outcomes may be expected to be similar to the general bariatric population…Any positive impacts of surgery on the management of symptoms relating to MS, such as ambulation, or upon the disease itself should be explored in future studies.”

To access this paper, please click here

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