• Sao Paulo Med J · Jan 2018

    Case Reports

    Bariatric surgery in individuals with severe cognitive impairment: report of two cases.

    • Everton Cazzo, Martinho Antonio Gestic, Murillo Pimentel Utrini, Felipe David Mendonça Chaim, Elaine Cristina Cândido, JarolavskyLuciana Bueno da SilveiraLBDSBSc. Head Nurse, Bariatric Surgery Outpatient Service, Hospital de Clínicas da Universidade Estadual de Campinas (HC-UNICAMP), Campinas (SP), Brazil., Ana Maria Neder de Almeida, José Carlos Pareja, and Elinton Adami Chaim.
    • MD, MSc, PhD. Assistant Lecturer, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
    • Sao Paulo Med J. 2018 Jan 1; 136 (1): 848884-88.

    ContextBariatric surgery has become the gold-standard treatment for refractory morbid obesity. Obesity is frequently associated with certain syndromes that include coexisting cognitive deficits. However, the outcomes from bariatric surgery in this group of individuals remain incompletely determined.Case ReportA 25-year-old male with Prader-Willi syndrome, whose intelligence quotient (IQ) was 54, was admitted with a body mass index (BMI) of 55 kg/m2, associated with glucose intolerance. He underwent the Scopinaro procedure for biliopancreatic diversion, with uneventful postoperative evolution, and presented a 55% loss of excess weight one year after the surgery, with resolution of glucose intolerance, and without any manifestation of protein-calorie malnutrition. A 28-year-old male with Down syndrome, whose IQ was 68, was admitted with BMI of 41.5 kg/m2, associated with hypertension. He underwent Roux-en-Y gastric bypass, with uneventful postoperative evolution. He presented a 90% loss of excess weight one year after the surgery, with resolution of the hypertension.ConclusionBariatric surgery among individuals with intellectual impairment is a controversial topic. There is a tendency among these individuals to present significant weight loss and comorbidity control, but less than what is observed in the general obese population. The severity of the intellectual impairment may be taken into consideration in the decision-making process regarding the most appropriate surgical technique. Bariatric surgery is feasible and safe among these individuals, but further research is necessary to deepen these observations.

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