Chest
Gastric Surgery for Respiratory Insufficiency of Obesity
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MATERIALS AND METHODS
Patients were considered for surgical treatment of obesity if (1) they weighed 45 kg (100 lbs) or more above ideal weight calculated from the 1959 height-weight tables of the Metropolitan Life Insurance Co.15 and (2) had failed to lose or maintain weight loss by supervised dietary manipulation for five years or more. Obese patients with respiratory failure were accepted without documentation of failed dietary management. Respiratory insufficiency of obesity comprised three groups of patients
Patient Population
Between March 1979 and February 1985, some 263 patients underwent surgery for morbid obesity. Of these, 161 patients had gastroplasty, and 102 had Rouxen-Y gastric bypass. Thirty-eight (14 percent) were identified with respiratory insufficiency of obesity; 25 of these had a gastroplasty and 13 a gastric bypass as their primary operation for obesity. Nine had SAS, ten had OHS, and 19 had both (Table 1). An associated pulmonary problem was present in 20 of these 38 patients, including heavy
DISCUSSION
The effects of morbid obesity on the respiratory system can be equated to placing a heavy weight on the chest wall. The ERV23 and total compliance of the respiratory system24 are decreased. Increased body mass necessitates an increased consumption of oxygen and production of carbon dioxide.25 Mild hypoxemia is common, but increased alveolar ventilation maintains PaCO2 within the normal range. Superimposed on these pulmonary abnormalities, characteristic of many individuals with simple obesity,
ACKNOWLEDGMENTS
We thank the medical and surgical house officers, nurse anesthetists, anesthesiologists, pulmonary function technicians, respiratory therapists, and nursing staff of the Medical College of Virginia for their outstanding efforts in the management of these very challenging patients.
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Manuscript received August 26; revision accepted December 11.