GROSSESSES APRÈS SLEEVE GASTRECTOMY (Article publié dans le Journal de Coeliochirurgie)
D. Krawczykowski1, Ph. Lemarié2, S. Koumaré3, M. S. Sbai-Idrissi4, C. Viry
1Maubeuge, 2Sens - FRANCE, 3Bamako - MALI, 4 Hôpital Simone VEIL- Eaubonne 95602 - FRANCE
RÉSUMÉ
L'obésité réduit la fertilité et accroit le taux de complications maternelles et néonatales. Près de la moitié des femmes opérées d'une chirurgie
bariatrique sont en âge de procréer.
La perte de poids après sleeve gastrectomy améliore la fertilité et réduit les comorbidités associées à l'obésité. La sleeve gastrectomy n'augmente pas le risque de complications maternelles et périnatales.
Toutefois les taux de complications restent intermédiaires entre ceux d'une population non-obèse et d'une population obèse. Ces grossesses restent à risques et nécessitent un suivi multidisciplinaire.
SUMMARY (KEY WORDS: Pregnancy, Obesity, Obesity surgery, Bariatric surgery, Sleeve gastrectomy, Perinatal outcome, Maternal complications, Neonatal outcome)
Background: Obesity increases the rate of maternal and newborn complications. More women of reproductive age are seeking bariatric surgery. For many years, sleeve gastrectomy is gaining acceptance as a weight loss surgery but there is still a lack of information regarding subsequent pregnancies.
The series: Based on the information gained at follow up consultation, among 492 SG (355 primary, 137 as a revision), there were 432 females and 45 recorded pregnancies in 38 women, but eventually 42 newborns. For those 38 patients, before SG mean age was: 28 (19-46); mean
BMI: 45.0 (29.4-61), 3 had type 2 diabetes, 5 hypertension, 3 SAS, 8 an obvious fertility problems, 18 GERD.
Results: Mean time elapsed between SG and pregnancy was: 27.2 months (4 – 87), mean BMI before pregnancy was 27.9 (20.3-45.9).
During the pregnancy mean weight fluctuation was + 10,5 kg (-27 to + 31). Only 2 patients were presenting vomiting after 3 months, 7 had a gestational T2D only one required insulin, 3 had hypertension, 1 preeclampsia, no SAS, 27 GERD.
Neonatal outcomes: premature delivery 8 (before 37 weeks), 5 after 42 weeks, the cesarean delivery encountered in 13, 8 low birth weight (<2,5 kg), no macrosomia, 1 late miscarriage (at 18 w) and 2 intra uterine deaths (1 at 26 w, 1 at 37 w).
Conclusion: Weight loss after SG seems to resolve fertility problems and to reduce the rate of maternal and some of newborns complications.