Inflammatory Bowel Disease Is Not a Contraindication
for Bariatric Surgery
Ignace M. C. Janssen
Edo O. Aarts
Marcel J. Groenen
Frits J. Berends
Published online: 27 December 2017
Springer Science+Business Media, LLC, part of Springer Nature 2017
Background Inflammatory bowel diseases (IBD) are listed as a contraindication for bariatric surgery in various guidelines due to
a theoretical higher complication risk. Therefore, little is known about safety and efficacy of bariatric surgery in IBD patients.
Aim We assessed the safety and efficacy of bariatric surgery and postoperative quality of life (QoL) in IBD patients.
Setting The study was conducted in a large peripheral hospital in the Netherlands.
Methods All IBD patients who underwent bariatric surgery in our facility were included. Complications, mortality, reoperations,
and micronutrient deficiencies were analyzed. Weight loss was assessed 6, 12, and 24 months after surgery. Postoperative QoL
was assessed using a disease-specific Inflammatory Bowel Disease Questionnaire (IBDQ).
Results Forty-five patients were included in this study, all diagnosed with IBD (16 ulcerative colitis (UC) and 29 Crohn’sdisease
(CD)) prior to bariatric surgery. Bariatric procedures included Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding,
and revisional surgery. There was no mortality in the entire follow-up period and there were no major perioperative complica-
tions. Two major complications in two CD patients occurred during follow-up, gastro-enterostomy bleeding and pyelonephritis
with secondary pancreatitis. Mean percentage (± SD) of overall excess weight loss (%EWL) and total body weight loss
(%TBWL), 12 months after surgery, were 62.9 ± 27.1 and 26.2 ± 10.6%, respectively. Twenty-four months postoperatively,
mean overall %EWL and %TBWL were similar for both UC and CD patients and were 62.9 ± 31.0 and 26.6 ± 12.2, respectively.
Mean Bariatric Analysis and Reporting Outcome System (BAROS) score was 3.34 ± 2.42. Median total IBDQ score was 170.8
(min. 77; max. 218). Both scores did not differ significantly between UC and CD patients.
Conclusion As bariatric procedures appear safe and effective in this CU and CD population, one could question why bariatric
surgery is contraindicated in the patients. Nevertheless, close lifelong monitoring to assure safety and a favorable outcome
Keywords Bariatric surgery
Inflammatory bowel diseases
Quality of life
Crohn’s disease (CD) and ulcerative colitis (UC), together
known as inflammatory bowel diseases (IBD), are fre-
quently associated with weight loss . However, as the
prevalence of obesity increases worldwide , there is
also an increase in the prevalence of obesity in patients
with IBD [3–5]. The Guidelines for Clinical Application
of Laparoscopic Bariatric Surgery of the Society of
American Gastrointestinal and Endoscopic Surgeons ,
endorsed by the American Society for Metabolic and
Bariatric Surgery, state that CD may be a relative contra-
indication to the Roux-en-Y gastric bypass (RYGB).
Furthermore, gastrointestinal disease is listed as a contra-
indication for bariatric surgery, based on expert opinion,
in for example, the Morbid Obesity Guideline of the
Association of Surgeons in the Netherlands .
CD is characterized by relapsing and remitting episodes of
transmural inflammation and skip lesions, potentially compli-
cated by fibrosis, fistulae formation, and obstructive disease. It
can involve the entire gastrointestinal tract, commonly affect-
ing the terminal ileum and/or colon. In UC, inflammation is
* Stephanie Aelfers
Rijnstate Hospital, Arnhem 6815 AD, Gelderland, Netherlands
Obesity Surgery (2018) 28:1681–1687