Weight loss surgery found safe in case of US woman with hEDS
Report noted no complications, substantial weight loss, for woman, 40
Weight loss surgery, medically known as metabolic and bariatric surgery, or MBS, can be safely performed in people with hypermobile Ehlers-Danlos syndrome (hEDS), according to two U.S. researchers behind a new case report.
The team detailed the case of a woman in California with hEDS who underwent two types of MBS — each time without complications — ultimately losing a substantial amount of weight.
“This report suggests that revisional MBS is safe in patients with hEDS, and no specific preoperative optimization, changes in operative technique or postoperative management is required,” the researchers wrote.
Still, the two scientists noted that “a thorough discussion with the patient of potential implications of a diagnosis of EDS should be part of informed consent” for individuals with the condition planning to undergo such weight loss surgery.
The study, “Outcomes of revisional bariatric surgery in patient with hypermobile Ehlers-Danlos syndrome,” was published in the Journal of Surgical Case Reports.
People with Ehlers-Danlos syndrome (EDS), of which hEDS is the most common type, have genetic mutations that affect connective tissue in the body, which is key to the structure of skin, joints, blood vessels, and other organs.
Overly mobile joints can lead to complications after surgery
Symptoms include overly mobile joints, soft and stretchy skin, and poor wound healing. Impaired healing processes can also leave people with EDS more susceptible to complications after surgery, especially gastrointestinal surgeries.
Metabolic and bariatric surgery, or MBS for short, encompasses a group of procedures used to treat obesity and related health problems such as type 2 diabetes or high blood pressure. Such surgeries make changes to the digestive system to limit how much a person can eat, alter the absorption of fat and calories, or both.
The diagnosis of EDS is rare, but given the high prevalence of obesity, it is anticipated that bariatric surgeons will encounter this diagnosis in their patients.
However, there are few reports of successful MBS in the EDS patient population.
“The diagnosis of EDS is rare, but given the high prevalence of obesity, it is anticipated that bariatric surgeons will encounter this diagnosis in their patients,” the researchers wrote, noting that it is thus critical to understand whether EDS patients can safely undergo MBS.
The 40-year-old woman with hEDS described in this case report was referred for MBS due to class III obesity, formerly called morbid obesity. Her condition was associated with high fat levels in the blood, fatty liver disease, back pain, and osteoarthritis — when the cartilage that lines the joints is worn down.
The woman had a history of excessive uterine bleeding and occasional bruising, but no other history of delayed wound healing. The specialized MBS team performed a thorough evaluation of the patient to optimize the surgical approach, according to the report.
Woman twice underwent weight loss surgery, both times safely
The patient underwent a type of MBS called laparoscopic sleeve gastrectomy, in which a large portion of the stomach is removed to limit food intake. She recovered without complications.
However, after three years, the woman had lost an inadequate amount of weight. She was started on a GLP-1 receptor agonist, a class of weight loss medications including the brand names Wegovy and Zepbound, but weight loss was still insufficient.
Her care team began preparing for another type of MBS called gastric bypass, where food is redirected past most of the stomach and into the small intestine. Again, the woman recovered well, and this time lost more weight.
The scientists indicated that their findings are consistent with the few other existing reports. A previous study reviewed the cases of seven people with EDS who underwent MBS, five of whom had hEDS.
While six of those individuals recovered well from surgery, one person with vascular EDS — a severe form of the disease in which the blood vessels and internal organs are commonly affected — had a postsurgical bleeding complication but ultimately recovered. Another study showed that MBS was successful in two adolescents with hEDS.
Taken together, these reports provide data to suggest that MBS is, overall, safe for people with hEDS without a need for major changes to the surgical approach, the researchers noted.
Still, “it is unclear whether this finding is generalizable to other subtypes of EDS,” the scientists wrote, adding that, in any case, it’s important for clinicians to discuss with patients the potential impact of EDS as part of obtaining consent for such surgery.
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