Limited weight loss with gastric banding in patients with craniopharyngeoma
Dirk Weismann1, Theresia Pelka1, Gwendolyn Bender1, Herrmann Müller3, Ursel Gebhardt3, Andreas Thalheimer2, Christian Jurowich2, Martin Fassnacht1 & Bruno Allolio1
While bariatric surgery is the most effective treatment strategy to maintain long-term weight-loss and to improve survival, it has not been shown, that bariatric surgery is as effective in craniopharyngeoma patients with hypothalamic obesity. We retrospectively analyzed weight loss and metabolic parameters in 7 craniopharyngeoma patients and 14 controls who underwent gastric banding surgery in five centers in Germany and Austria. The last before and the first patient after the craniopharyngeoma patient were included as controls. Craniopharyngeoma patients were significantly younger (17.4 (13.624.0) vs 37.8 (26.256.7) years, P<0.001) when bariatric surgery was performed. However, body weight was not significantly different at the time of bariatric surgery (46.5±2.6 vs 49.7±2 kg/m2, P=0.4). Although data are incomplete, one of 6 patients in the craniopharyngeoma group was taking antidiabetic drugs preoperatively and the need for treatment persisted postoperatively. None of 6 patients was taking antihypertensive or cholesterin lowering drugs. Maximum (−13 (−43 −2) vs −28 (−40±35) kg, P<0.001) and mean weight loss (−8 (−36±9.4) vs −20.5 (−39±32.5), P<0.001) was moderate in craniopharyngeoma patients and significantly less compared to controls during a follow up period of 24 months. Total cholesterol increased from 158±8 to 202±12 mg/dl, P<0.05. In three patients repeated surgical interventions were performed because of insufficient weight loss. Two patients received three bariatric surgical interventions. In one patient a gastric sleeve was performed and one patient later received a gastric bypass. After gastric bypass, this patient significantly lost weight.
We conclude, that gastric banding is less effective in patients with craniopharyngeoma compared to obese patients without hypothalamic disease. The value of other bariatric surgical procedures for patients with craniopharyngeoma related obesity warrants further study.