Long-term outcomes after gastric bypass surgery in patients with craniopharyngioma-related hypothalamic obesity-Three cases with 7, 8, and 14 years follow-up

Introduction: Craniopharyngioma is a brain tumor, resection which often results in hypothalamic damage leading to severe obesity. While small case series and case-control studies have shown the benefits of bariatric surgery in patients with craniopharyngioma-related hypothalamic obesity, long-term results (>5 years) have not been re -ported so far.Methods: We analyzed data from 3 cases with craniopharyngioma-related hypothalamic obesity who had un-dergone (one proximal, two very long limb distal) Roux-en Y gastric bypass (RYGB) surgery 7, 8, and 14 years before their latest follow-up visit.Results: Percentage of total weight loss varied across the 3 patients (11%, 26%, 32%). Preexisting type 2 diabetes markedly improved in 2 patients with one showing a temporary and one a persisting remission. At RYGB surgery one patient was diagnosed to have liver cirrhosis (intraoperative biopsy), but liver function remained stable or even improved during a 7-year follow-up period. One patient required proximalisation of lower anastomosis (distal RYGB) because of severe hypoproteinemia and diarrhea which resolved after revision. Another patient temporarily developed alcohol abuse that led to weight regain, but his weight decreased when alcohol con-sumption became under control. Importantly, all three patients stated in a standardized questionnaire that they have benefited and that they would recommend RYGB surgery to another person.Conclusion: Despite showing an unsatisfying weight loss result in one patient and distinct complications in the other two patients, all patients clearly showed long-term persisting benefits. Moreover, self-reported outcomes confirm that it was the right decision to recommend RYGB to our patients displaying craniopharyngioma-related hypothalamic obesity.