Bariatric Surgery in Patients With Prader-Willi Syndrome.

Abstract

Prader-Willi Syndrome (PWS) is a genetic disorder characterized by insatiable hyperphagia, resulting in severe, early-onset obesity that is often refractory to conventional management. The associated comorbidities and reduced life expectancy in PWS present a significant therapeutic challenge. This review synthesizes the existing literature on the controversial role, outcomes, and complexities of bariatric surgery in patients with PWS. In recent decades, bariatric surgical techniques have evolved from malabsorptive or restrictive operations to modern procedures such as sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). We present a 21-year-old male's SG case to illustrate key themes. Published series from specialized, high-volume centers demonstrate that SG and RYGB yield significant short- to mid-term weight loss and metabolic improvement with an acceptable perioperative risk profile. However, the fundamental challenge in PWS remains the persistent, inherent hyperphagia. As exemplified by the presented case and supported by the broader literature, this insatiable hunger severely limits long-term surgical success and frequently leads to substantial weight regain. Maintaining durable success requires rigorous, lifelong external dietary supervision and intensive multidisciplinary support. Moreover, ethical considerations, particularly regarding informed consent and procedural choice, complicate the application of bariatric surgery in this population. Bariatric surgery should therefore be considered an adjunctive tool rather than a definitive cure for PWS-related obesity. Its use must be reserved for carefully selected individuals who have severe comorbidities and robust, long-term support structures in place. This perspective highlights the critical need for ongoing research into optimal patient selection, procedural approaches, and adjuvant therapies to improve durable outcomes.