2019 General Surgery Presentations

Kyle D Gadbois, MD, Kyle D Checchi, MD, Cassidy West-Santos, MD, Gordon G Wisbach, MD; Department of General Surgery, Naval Medical Center San Diego

INTRODUCTION: Obesity is an increasing challenge for the Unites States Military.  Apart from exposing military personnel to long-term health complications, the obesity crisis threatens mission readiness and places substantial financial burden on the Department of Defense.  Although bariatric operations for weight loss are safe and have demonstrated the best weight loss outcomes for those with morbid obesity, active duty personnel are prohibited from undergoing permanent surgical procedures for weight loss.  We present six active duty service members challenged by obesity who were unsuccessful in remaining within Navy Weight Standards by diet and exercise alone and were enrolled in our endoscopic intragastric balloon (IGB) program.

METHODS: We enrolled active duty patients who participated in our standard preprocedural risk mitigating medical evaluation, completed NIH guideline prerequisites for bariatric surgery, qualified for IGB per FDA guidelines, and were interested in the program.  All patients obtained command authorization prior to IGB placement and were intended to be treated with the IGB for 6 months.  After placement, patients were followed at regular intervals by their bariatric surgeon and dietician as part of a year-long structured lifestyle modification program.  This report describes the experience of the first six active duty patients who have received the IGB using data available from our institution’s Bariatric Surgery Registry, the electronic medical record, and patient surveys.

RESULTS: The IGB resulted in weight loss for all three of the patients for whom complete data is available.  The average BMI of the patients decreased 1.5 (SD=0.8, p=0.09) representing an average 13.4% loss of excess body weight (range 11.0%-15.6%).  BCA and PFA information before and after enrollment in the IGB program will be presented.  Of the six total patients undergoing treatment, only one major complication has occurred.  In that case, the patient experienced a gastric perforation necessitating early endoscopic balloon extraction and laparoscopic repair. She recovered well. All other patients tolerated the full 6 months of IGB treatment. 

CONCLUSIONS: The IGB is an effective temporary weight loss procedure available to active duty patients with obesity.  Despite one complication requiring early urgent device removal and surgical repair, the device appears safe for use in the active duty population.  Our center developed many beneficial lessons learned from launching this new program.  Further research is needed to determine if the IGB can improve readiness, increase retention of personnel, and improve individual health benefits in order to justify wider utilization of the IGB in active duty personnel.