Usefulness and Safeness Of Intra-Gastric Balloon Before Bariatric Surgery In Morbid Obesity

Treatment with an intragastric balloon (IGB) for morbid obesity is a temporary treatment reached as a second step, when the initial nutritional multidisciplinary approach has failed; however, its value is not clear compared with other conventional medical treatments ], though some authors have stated that IGB achieves higher weight loss than conventional diet treatments (12.2% of the initial weight) ]; and others have positioned IGB as the first valid step in order to achieve weight loss in patients who are adequate for a future gastric bypass surgery. Genco et al (2009) have compared the treatment with IGB only vs. laparoscopic sleeve gastrectomy (LSG), and have found no differences in the amount of weight loss at 6 months, but a reduction in adverse events caused by IGB treatment.

One of the potential future indications for the intragastric balloon could be its use as a bridge-treatment until bariatric surgery, not only in order to achieve weight loss before surgery, but also to select the group of patients who might benefit more from derivative surgery, as suggested by some authors or its use in special populations such as super-obese patients . The objective would be to reduce weight before the surgical procedure, in order to improve comorbidities, facilitate the surgical technique, and potentially reduce any surgical complications.

It is increasingly frequent in many surgical units to try and achieve weigh loss before bariatric surgery, using intragastric balloons (IGB). However, this therapeutic approach currently presents dubious utility. Our study intends to contribute with our experience in the evaluation of IGB before surgery for achieving weight loss, and its impact on post-surgical morbidity.

Bariatric surgery shows an important morbidity and there are not to many randomized prospective studies using intragastric- balloons (IGB-BIB®) to evaluate if getting weight lost really matter on decreasing surgical complications before Bariatric surgery OBJECTIVE: To study the usefulness of preoperative IGB-BIB® "grA" [sleeve resection (SR) or gastric bypass (GB)] to help decrease postsurgical complications. Secondly we try to check the rate of IGB-BIB® failures (a total weight loss less than 10% of the initial weight), and the impact on decreasing hospital stay and rate of surgical reoperations. METHODS: The study was a clinical prospective and randomized essay coming from 2009. Cases (grA) had an IGB during 6 months before surgery vs Controls (grB)

Inclusion criteria

• - Morbid obesity (BMI ≥ 40 kg/m2 ) with a failed Conventional Medical treatment
• - Morbid obesity (BMI ≥ 35 kg/m2) with important comorbidity with a failed Conventional Medical treatment
• - they should be operated by a laparoscopic gastric sleeve or by laparoscopic gastric by-pass

Exclusion criteria

• - Slight adherence to previous medical treatments .
• - Hiatal hernia more than 3 cms
• - Patients with active gastric or duodenal ulcer disease
• - Severe esophagitis
• - Psychiatric diseases (depression, bulimia etc)
• - Associated Severe Systemic Disease not amenable to improve with weight loss
• - Patients with Inflammatory bowel diseases
• - Patients on anticoagulant treatment or steroids .
• - Addiction to Drugs or alcohol
• - Past history of gastric surgery ,antireflux surgery or any other type of bariatric surgery
• - Patient refusing to be followed 6 months before and after surgery
• - Pregnancy or foreseeable pregnancy during the study
• - Patients with gastric or esophageal varices
• - proton pump inhibitor (PPI) allergy