2020 General Surgery Presentations

Joshua Dilday, DO, Chelsey McKinnon, MD, Cara Reitz, MD, Eric Ahnfeldt, DO, John P Sanders, MD; William Beaumont Army Medical Center

OBJECTIVES: The American College of Metabolic and Bariatric Surgery (ASMBS) and the American College of Obstetrics and Gynecologists (ACOG) recommend delaying pregnancy for 12-24 months after bariatric surgery. However, weight loss is known to augment fertility and patients may purse bariatric surgery for this benefit. Despite studies evaluating maternofetal outcomes after bariatric surgery, long-term weight loss has not been evaluated in patients becoming pregnant before the current guideline recommendations. We sought to determine patient adherence to these recommendations and the effect of early postoperative pregnancy on long-term weight loss.

METHODS: A retrospective review of female patients undergoing initial bariatric surgery from 2008-2017 at a military bariatric center was performed. Cohorts were separated by presence and timing of postoperative pregnancy (not pregnant, <12 months, 12-24 months, and >24 months). BMI and percent excess weight lost (%EWL) were collected at 6 months and yearly for 5 years. Patient characteristics and comorbidities were evaluated.

RESULTS: Four hundred fifty-one patients were evaluated. The average age was 36.6 years and the average preoperative BMI was 42.79kg/m2. Sleeve gastrectomy was the most common procedure performed (n=239; 53%) Fifteen percent became pregnant after bariatric surgery (n=67). Thirty-seven percent of postoperative pregnancy occurred within 12 months; 35% occurred at 12-24 months; 27% occurred after 24 months. Short term weight loss was similar between groups as no difference in %EWL was seen at 6 months (p=0.9), 12 months (p=0.24), and 24 months (p=0.37). Postoperative pregnancy did not negate weight loss, as all groups had EWL>50% at 24 months. Regarding long term weight loss, no difference in %EWL was seen between pregnant and non-pregnant patients when followed annually for 5 years (p=0.89).

CONCLUSION: Current guidelines recommend delaying pregnancy for 12-24 months after bariatric surgery. Fertility augmentation may be a deciding factor in patients pursuing bariatric surgery, and early conception may be a specific patient goal. Despite proper counseling regarding the recommendations, many patients may not adhere to these guidelines for a variety of reasons. Regarding both initial and long-term weight loss, non-adherence to these guidelines was not detrimental. Postoperative pregnancy before 12 months did not affect initial or overall weight loss.