title: The safety and efficacy of bariatric surgery for obese, wheelchair bound patients.
abstract: BACKGROUND
  The aim of this study was to evaluate outcomes of bariatric surgery performed in order to improve mobility in patients with severe mobility limitations.
  
  
  METHODS
  Patients with severe mobility impairment (wheelchair bound) who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic adjustable gastric banding (LAGB) surgery to improve their mobility were included in this study. Patients were identified between July 2009 and October 2011 using an electronic prospective bariatric database. Mobility was assessed by questionnaire during clinic follow-up appointments.
  
  
  RESULTS
  Fifteen patients (11 female, 4 male) with a mean age of 48 years (range: 26-71 years) and a mean body mass index of 46 kg/m(2) (range: 33-54 kg/m(2)) were included. Seven patients (47%) underwent LAGB and eight (53%) LRYGB. The aetiologies of mobility impairment included advanced osteoarthritis (n=6), spinal conditions (n=4), severe bilateral leg oedema and ulceration (n=2), advanced rheumatoid arthritis (n=2) and traumatic paraplegia (n=1). The mean length of hospital stay was 3.8 days. There was no mortality. One patient was lost to follow-up. Of the remaining 14 patients, the mean excess weight loss percentage at a mean of 18.5 months postoperatively was 48% (68% for LRYGB, 20 months; 29% for LAGB, 17 months). Ten patients reported improved mobility. Reduced pain, improved independence and ability to transfer were most commonly cited. Four patients reported no improvement in mobility (three LAGB patients, one LRYGB patient).
  
  
  CONCLUSIONS
  Bariatric surgery can safely improve mobility and quality of life in obese patients with severe mobility impairment. Our paper supports the idea that severe mobility impairment should be considered an indication for bariatric surgery in selected patients. LRYGB demonstrated better weight loss and mobility improvement than LAGB. Larger studies are required to establish robust selection criteria for surgery in this group.
authors.affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Williams
authors.forename: P A
authors.initials: PA
authors.lastname: Georgiou
authors.forename: D M
authors.initials: DM
authors.lastname: Cocker
authors.forename: G
authors.initials: G
authors.lastname: Bonanomi
authors.forename: J
authors.initials: J
authors.lastname: Smellie
authors.forename: E
authors.initials: E
authors.lastname: Efthimiou
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000601:surgery*; D009767:Obesity, Morbid / Q000601:surgery*; D061214:Patient Safety; D011788:Quality of Life; D016896:Treatment Outcome; D015431:Weight Loss; D014910:Wheelchairs; D055815:Young Adult