Long-term Follow-up of Gastroplasty in a Patient with Prader-Willi Syndrome

Abstract

To prevent the development of metabolic disturbances caused by overeating, we performed vertical banded gastroplasty in an adult woman with Prader-Willi syndrome. Her fasting blood sugar (FBS) and urinary sugar excretion (US) decreased during 6 months after the surgery under strict dietary control in the hospital. The insulin response to oral glucose at 6 months after surgery was as good as in the normal controls. A barium meal study in the 11th postoperative month revealed that the staple line was partially ruptured. After this, FBS and US increased, and the glucose tolerance and insulin response worsened. At 24 months, US was still less than preoperative US, and the oral glucose tolerance test showed a better result than before operation. At 29 months, her condition was brought under control with use of Glibenclamide. At 60 months, her FBS and US were at the same level as before operation. She was doing a part-time job. In conclusion, the effect of gastroplasty in preventing worsening of glucose metabolism in a case of Prader-Willi syndrome lasted satisfactorily for 24 months in spite of the partial breakdown of the staple line.

BioEnterics Intragastric Balloon for Treatment of Morbid Obesity in Prader–Willi Syndrome: Specific Risks and Benefits

“…Yet, in these patients, a drastic body weight reduction is mandatory to reduce the risk of cardio-respiratory and metabolic complications and to improve life expectancy. In the last three decades, several bariatric surgical techniques were applied to treat morbid obesity in PWS patients, such as trunkal vagotomy [13], jejunoileal bypass [14,15], vertical banded gastroplasty [16,17], adjustable silicon gastric banding [18], gastric bypass [19], and biliopancreatic diversion (BPD) [20][21][22][23][24][25][26]. However, a higher morbidity and mortality rate in these patients, compared to those with simple obesity, has been reported [27].…”

Abordagem terapêutica da obesidade na Síndrome de Prader-Willi

“…A gastroplastia vertical foi realizada em uma paciente com SPW, tendo ocorrido ruptura parcial da linha de grampeamento no 11 o mês pós-operatório (50). O comportamento alimentar da paciente pode ter sido a causa para a falência da gastroplastia.…”

Prader-Willi syndrome–associated obesity treated by biliopancreatic diversion with duodenal switch. Case report and literature review

“…Table 3, 42 patients (including our case) with PWS-associated obesity treated with bariatric surgery were found in the English literature. Several surgical techniques have been reported on the matter, such as trunkal vagotomy [17], jejunoileal bypass [13,18,19], vertical banded gastroplasty (VBG) [20,21], adjustable silicon gastric banding [22], gastric bypass [23,24], and BPD [14,15,[25][26][27]. However, the optimal procedure is far from settled.…”

“…Gastric restrictive operations, VBG [20,21], and adjustive silicon gastric banding (ASGB) [22], despite their initial encouraging results, failed to maintain long-term weight loss [20,21], probably because of the poor patient compliance after the intervention. Mason et al [21] reported 2 patients with PWS-associated obesity treated with VBG.…”

“…The other patient lost only 30% of his initial excess weight within 5 years and regained it immediately afterward. Dousei et al [20] also concluded that VBG was unable to achieve a complete long-term effect on body weight loss and glucose metabolism. Their patient's weight, 29 months after the operation, was even greater preoperatively, whereas the use of oral hypoglycemic agents was necessary to control blood glucose levels.…”