Management of Obesity Associated Airway Problems with Bariatric Surgery

Bariatric surgery is known to be an effective treatment strategy for a variety of obesity related medical comorbidities. Obesity associated airway disease poses a significant morbidity and mortality risk. Individuals with obesity are at higher risk of developing respiratory infections, report negative quality of life scores, longer and increased hospitalisation rates as well as being more susceptible to life threatening emergencies such as cardiorespiratory arrest in comparison to healthy weight individuals.

This book chapter summarises the evidence base of the management of some obesity related airway pathologies, obstructive sleep apnoea (OSA), asthma and chronic obstructive pulmonary disease (COPD) as well as laryngotracheal stenosis (LTS) with bariatric surgery.

The literature base for the management of OSA and asthma with bariatric surgery is plentiful, with most of the evidence demonstrating a significant improvement of symptoms with weight loss achieved through various bariatric interventions (gastric band, sleeve gastrectomy and roux en-Y-gastric bypass). However, with LTS, the impact of bariatric surgery as a treatment modality is novel and subsequently the evidence is largely unknown. To date, there is only one prospective multicentre observational study that has evaluated the impact of bariatric surgery on clinical outcomes in LTS patients, yielding encouraging results. Individuals not only benefited from a reduction in the number of interventions that were required to manage the symptoms of LTS, but bariatric surgery also enabled more patients to successfully undergo definitive surgical treatment through effective pre-operative optimisation achieved through weight loss.

Given the effectiveness of bariatric surgery for the management of these airway diseases; OSA, asthma and LTS may be considered as airway pathologies that can be safely and effectively treated by metabolic surgery. This may be reflected in updated national and international guidelines created by learned bodies such as the International Federation for the Surgery of Obesity and Metabolic Disorders to guide the bariatric and metabolic communities.