Mini Gastric Bypass in the Treatment of Prader Willi Syndrome. A Case Report with Two Years of Follow Up

Introduction: Prader-Willi syndrome (PWS) is a genetic disorder mainly characterized by hyperphagia and early-childhood onset obesity. Because of behavioral and cognitive problems causing the failure of any dietary control program, bariatric surgery appears to be the appropriate therapy in these patients. In this study we present our experience of treating PWS-associated obesity with laparoscopic mini-gastric bypass (LMGBP). This is the second published case of PWS treated by LMGB so far. Patient and Method: A 16 y.o. boy with PWS, BMI of 54,8 Kg/m2 , hypertension and frequent severe sleep apnea crisis, was referred to our department. The patient underwent a LMGB at about 190 cm from the Treitz ligament. Main preoperative parameters as BMI, ghrelin levels, CPK. Hb A1C, arterial pressure and EGA were respectively: 54,8 Kg/m2 ; 1163,7 pg/ml; 148 u/L; 5,9%; 150/100 mm/Hg; 95% sat O2. Results: The postoperative period was uneventful and the young patient was discharged five days following surgery. Two years later main parameters are: BMI 40.6 with an EWL of 44 %; fasting plasma acyl ghrelin 353,1 pg/ml; CPK 65 u/L; Hb A1C 5,1 %; arterial pressure 130/75 mmHg without therapy and 99% sat O2. The resolution of sleep apnea disorder has been recorded as well. An oral multivitamin and iron implementation is daily administered in order to treat iron deficiency anemia. Conclusion: Although larger series and longer follow up are needed, according to these data, LMGBP seems to be a valid approach for the treatment of PWS associated obesity.