Endocrine Abstracts

Introduction: Obesity-related complications are the main causes of morbidity and mortality in Prader–Willi syndrome (PWS) patients. We report a case of a 17-year-old patient with PWS who had metabolic complications of poorly controlled diabetes mellitus (HbA1c 8.3% on 56 units of insulin daily) and obesity (BMI 33 kg/m²). He underwent laparoscopic assisted duodenal switch but unfortunately died from aspiration pneumonia 3 days after surgery. A literature search was conducted to review the various surgical techniques, long-term outcomes and the recurrence rates of obesity after each procedure in these patients.

Results: The bariatric procedures performed will be presented. Among individuals with PWS, 37% underwent biliopancreatic diversion (BPD), 29% Roux-en-Y gastric bypass (RYGBP), 18% intragastric balloon, 6% vertical banded gastroplasty (VBG), 3% biliopancreatic diversion with duodenal switch (BPPDS), 3% jejunoileal bypass (JB), 1.5% truncal vagotomy, 1.5% adjustive silicon gastric banding (ASGB).

Restrictive bariatric surgery, such as gastric banding or bypass, has not been shown to reduce hyperphagia or achieve long-term weight reduction. In fact, it is associated with unacceptable morbidity and mortality. On the other hand, BPD and BPPDS were reported to result in successful weight loss but there were frequent complications from the resulting intestinal absorption. Roux-en-Y gastric bypass (RYGBP) appears to have better long-term results in terms of sustained weight loss but with a high rate of revision of gastric pouch.

Conclusion: Although case reports and small case series have documented good improvement in metabolic profile and weight loss with bariatric surgery in PWS, there is a paucity of data on long-term effects.