Background

Many patients undergoing sleeve gastrectomy (SG) have medical conditions necessitating chronic immunosuppressive therapy (CIT). CIT use has been associated with increased surgical complications, including infections, leaks, and impaired wound healing. However, there is limited data on whether brief interruption of CIT before and after surgery mitigates these risks. We aim to elucidate the differences in short-term outcomes following SG in patients who interrupted CIT medications compared to those who maintained them.

Methods

A retrospective review of patients undergoing primary SG with preoperative BMI>=35kg/m2 while on CIT. Patients were divided into 2 groups depending on whether CIT was temporarily discontinued before and after the procedure. Patient baseline characteristics, operative characteristics, and postoperative outcomes up to 6-months were analyzed. Patients with simultaneous transplant were excluded.

Results

75 patients with mean age 48.1+-10.8 years and BMI of 42.6+-8.8 kg/m2 were included. Participants who discontinued CIT (n=20,26.7%) were comparable to those who maintained it (n=55,73.3%). Primary indications for CIT were renal transplantation (n=39,52%), rheumatoid arthritis (n=11,14.7%), and liver transplantation (n=9,12%). Patients who maintained CIT had significantly higher readmission (21.8% vs. 0%,p=0.029) and early complication rates (27.3% vs. 5%,p=0.045). Early complications in the group that maintained therapy included bleeding(n=4), urinary infections(n=2) and wound infections(n=2). Late complications included staple line leaks(n=2) and wound seroma(n=1).

Conclusions

Patients on CIT who refrain from interrupting therapy exhibit significantly higher rates of readmission and 30-day complications compared to those who interrupt. It is advisable to discontinue CIT therapy briefly before and after surgery, whenever possible, to minimize risks.