Intragastric balloon reduces liver volume in super-obese patients, facilitating subsequent laparoscopic gastric bypass

Background: Surgery in patients with super-obesity (BMI >= 50) involves technical difficulties that are related, among other factors, to increased liver volume. Although the intragastric balloon is not a definitive alternative to surgery, it has been used in these patients as a primary therapeutic means of reducing excess weight and the risks of subsequent surgery. It has also been reported to considerably diminish liver volume to facilitate technical aspects of the operation. We evaluated preoperative weight loss in patients with super-obesity after placement of an intragastric balloon and its effect on liver volume measured by computed axial tomography (CT) prior to laparoscopic Roux-en-Y gastric bypass (LRYGBP). Methods: The balloon was implanted preoperatively under endoscopic guidance and sedation in 31 patients with super-obesity, to reduce weight prior to LRYGBR Two patients were excluded from the study for intolerance and the balloon was removed 2 weeks after placement. Measurement of liver volume was done with axial images obtained by spiral CT with a section thickness of 10 mm, reconstitution index 10 mm, pitch 1.5 and acquisition delay 60 seconds. Volumes were calculated using the sum of areas technique. Measurement of volume was done in these 29 patients prior to balloon placement and the week before surgery. Results: After placement of the balloon, 27 patients (93%) had nausea and 25 patients (86%) had vomiting, which abated 1 week after placement. Mean liver volume prior to balloon placement was 2938.53 +/- 853.1 cm 3, which at 6 weeks dropped to values of 1918.2 +/- 499.8 cm(3), revealing a considerable reduction in liver volume [31.8% +/- 18.16% (range 3.1%-58.5%)]. Percent of excess weight loss was 22.14% +/- 7.39. LRYGBP was performed at 6 months. Conclusions: In patients with super-obesity, preoperative treatment with intragastric balloon considerably reduces liver volume to facilitate LRYGBP.