Metabolic and Bariatric Surgery for Obesity in Prader Willi Syndrome: Systematic Review and Meta-Analysis

Background Obesity is the leading cause of morbidity and mortality in patients with Prader-Willi Syndrome (PWS). Objectives To compare changes in body mass index (BMI) after metabolic and bariatric surgery (MBS) for the treatment of obesity (BMI ≥35 kg/m2) in PWS. Methods A systematic review of MBS in PWS was performed using PubMed, Embase and Cochrane Central identifying 254 citations. Sixty-seven patients from 22 articles met criteria for inclusion into the meta-analysis. Patients were organized into three groups: laparoscopic sleeve gastrectomy (LSG), gastric bypass (GB), and biliopancreatic diversion (BPD). Results No mortality within one year was reported in any of the three groups after a primary MBS operation. All groups experienced a significant decrease in BMI at 1 year with a mean reduction in BMI of 14.7 kg/m2 (p-value \u3c0.001). The LSG groups (n=26) showed significant change from baseline in years 1, 2, and 3 (p-value at year three=0.002) but did not show significance in years 5, 7, and 10. The GB group (n=10) showed a significant reduction in BMI of 12.1 kg/m2 in the first two years (p-value=0.001). The BPD group (n=28) had a significant reduction in BMI through seven years with an average reduction of 10.7 kg/m2 (p-value=0.02) at year seven. Conclusion Individuals with PWS who underwent MBS had significant BMI reduction sustained in the LSG, GB, and BPD groups for three, two, and seven years respectively. No deaths within one year of these primary MBS operations were reported in this study or any other publication