Super morbid obesity for gynae non-cancer surgery

PIG Meeting: 8th July 2021

66yo lady for laparoscopic hysterectomy and BSO for complex ovarian cyst. Tumour markers negative, thought non-cancerous.


  • Recurrent TIAs/syncopal events, ongoing for many years. Well known to neurologist. Normal cerebral imaging. DDX; epilepsy vs anxiety related.
  • Patient declined loop recorder to exclude bradyarrhythmias
  • Possible PFO – Echo showed aneurysmal and mobile intra-atrial septum. R-to-L shunt. Patient declined F/U for assessment of PFO and closure if indicated. Episodes could represent recurrent micro-embolic episodes via the PFO.
  • Cerebral aneurysm clipping 2013
  • Smoker, 45PYH
  • Thyroidectomy
  • Severe anxiety and depression. ++ psychosocial issues


  • Syncopal episodes of unknown origin, likely not organic cause but need to exclude PFO and bradyarrhythmia


  • PFO and laparoscopic surgery – risk of venous air embolism. It is not prudent to proceed while this issue has not been resolved.
  • Given the gynae procedure is not urgent but the patient is keen to proceed, this provides a timescale to follow up these medical issues.


  • Clinic doctor to liaise with surgical team/GP to ensure issues are investigated/managed appropriately prior to procedure.