DOCSLIB.ORG

Effect of Gastric Bypass Surgery on Kidney Stone Disease

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Effect of Gastric Bypass Surgery on Kidney Stone Disease Effect of Gastric Bypass Surgery on Kidney Stone Disease Brian R. Matlaga,* Andrew D. Shore, Thomas Magnuson, Jeanne M. Clark, Roger Johns and Martin A. Makary From the Departments of Urology, Surgery, Anesthesiology and Medicine, the Johns Hopkins University School of Medicine, and the Departments of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland Purpose: Recent studies have demonstrated that mineral and electrolyte abnor- Abbreviations malities develop in patients who undergo bariatric surgery. While it is known and Acronyms that these abnormalities are a risk factor for urolithiasis, the prevalence of stone BCBS ϭ Blue Cross Blue Shield disease after bariatric surgery is unknown. We evaluated the likelihood of being BMI ϭ body mass index diagnosed with or treated for an upper urinary tract calculus following Roux-en-Y ϭ gastric bypass surgery. JI jejunoileal Materials and Methods: We identified 4,639 patients who underwent Roux-en-Y RYGB ϭ Roux-en-Y gastric bypass gastric bypass surgery and a control group of 4,639 obese patients who did not have surgery in a national private insurance claims database in a 5-year period (2002 to Submitted for publication October 15, 2008. 2006). All patients had at least 3 years of continuous claims data. Our 2 primary Supported by The Hariri Family Foundation, and Mr. and Mrs. Chad and Nissa Richinson. outcomes were the diagnosis and the surgical treatment of a urinary calculus. The data set used in this study was originally Results: After Roux-en-Y gastric bypass surgery 7.65% (355 of 4,639) of patients created for a different research project on patterns were diagnosed with urolithiasis compared to 4.63% (215 of 4,639) of obese of obesity care within selected BCBS plans. The Ͻ previous research project (but not the current study) patients in the control group (p 0.0001). Subjects in the treatment cohort more was funded by unrestricted research grants from commonly underwent shock wave lithotripsy (81 [1.75%] vs 19 [0.41%], Ethicon Endo-Surgery, Inc. (a Johnson & Johnson p Ͻ0.0001) and ureteroscopy (98 [2.11%] vs 27 [0.58%], p Ͻ0.0001). Logistic company); Pfizer, Inc and GlaxoSmithKline. The data and database development support and guidance regression demonstrated that Roux-en-Y gastric bypass surgery was a significant were provided by the BCBS Association, BCBS of predictor of being diagnosed with a urinary calculus (OR 1.71, CI 1.44–2.04) as Tennessee, BCBS of Hawaii, BCBS of Michigan, well as undergoing a surgical procedure (OR 3.65, CI 2.60–5.14). BCBS of North Carolina, Highmark, Inc. of Pennsyl- Conclusions: vania, Independence Blue Cross of Pennsylvania, Roux-en-Y gastric bypass surgery is associated with an increased Wellmark BCBS of Iowa and Wellmark BCBS of risk of kidney stone disease and kidney stone surgery in the postoperative period. South Dakota. Clinicians should be aware of this hazard and inform patients of this potential * Correspondence: James Buchanan Brady complication. Future studies are needed to evaluate preventive measures in the Urological Institute, The Johns Hopkins University School of Medicine, 600 North Wolfe St., Balti- high risk population. more, Maryland 21287 (telephone: 410-550-3506; FAX: 410-550-3341; e-mail: [email protected]). Key Words: kidney, calculi, bariatric surgery, epidemiology OBESITY has become a leading public result in sustained and significant health epidemic with recent estimates weight loss in the majority of candidate that 30% of American adults are obese morbidly obese patients. In fact, the (BMI greater than 30).1 Even more number of bariatric procedures per- alarming is the trend that prevalence formed in the United States increased rates are increasing rapidly,1 creating a 5-fold from 1998 to 2002.3 deferred societal burden of type II dia- The earliest surgical therapy for betes, heart disease, hypertension, the treatment of obesity was the mal- pregnancy complications, sleep apnea absorptive JI bypass procedure. Al- and other health problems.2 Bariatric though JI bypass did induce rapid surgery is the only therapy to date to and lasting weight loss, increasing ex- our knowledge that has been shown to perience with the procedure led to the 0022-5347/09/1816-2573/0 Vol. 181, 2573-2577, June 2009 ® THE JOURNAL OF UROLOGY Printed in U.S.A. www.jurology.com 2573 Copyright © 2009 by AMERICAN UROLOGICAL ASSOCIATION DOI:10.1016/j.juro.2009.02.029 2574 GASTRIC BYPASS SURGERY AND KIDNEY STONE DISEASE recognition of serious postoperative sequelae such as a BMI greater than 35 and 3 continuous years of followup liver failure, osteomalacia, nephrolithiasis and renal data were selected and assigned an index date of 7 months failure.4 Nephrolithiasis and renal failure were in- after the first month of enrollment to match the median duced by over-absorption of dietary oxalate, which interval between first enrollment and surgery in the treat- resulted in severe hyperoxaluria.5 As a consequence ment group. We excluded from the treatment and control groups female subjects who were pregnant the year be- of these metabolic consequences the JI bypass was fore, the year of or the year following an obese BMI value. abandoned and in 1979 the Food and Drug Admin- We also excluded anyone with a preexisting renal disease 6 istration requested a moratorium on the procedure. diagnosis or who had undergone treatment of an upper The Roux-en-Y gastric bypass overcame many urinary tract calculus (64 and 62 patients, respectively). of the malabsorptive problems associated with JI The 2 groups were matched using the SurveySelect bypass, and is recognized as a safe and effective procedure (SAS®, 2003) on the basis of age (18 to 24, 25 to therapy.3,7 However, some reports have suggested 34, 45 to 54, 55 to 64, 65 to 74 and 75 to 84 years), gender, that patients undergoing certain types of bariatric diagnosis of diabetes or prescription for an antihypergly- surgery such as RYGB are at increased risk for cemic agent at any time before the date of surgery or index postoperative hyperoxaluria. It is not known date, and presence of a diagnosis of hypertension or a whether this hyperoxaluria will ultimately result claim for an antihypertensive medication within 6 months of the surgery/index date. One-to-one sampling with prob- in symptomatic renal calculi as it did in patients 8–10 ability proportional to size was used. undergoing JI bypass. To address this ques- The main dependent variables examined in this study tion we designed a study to measure the preva- were a stone removal procedure (shock wave lithotripsy, lence of kidney stone disease following modern ureteroscopy, nephrolithotomy) and a diagnosis of urinary RYGB surgery performed for bariatric indications. calculi (an exclusion criterion if preexisting). The codes used to define these procedures and conditions can be found in Appendix 2. In terms of analysis simple chi- MATERIALS AND METHODS square tests and logistic regression were performed. SAS® The data and in-kind database development support and version 9.13 was used for all analyses. guidance were provided by the Blue Cross/Blue Shield Association, BCBS of Tennessee, BCBS of Hawaii, BCBS RESULTS of Michigan, BCBS of North Carolina, Highmark, Inc. (of Pennsylvania), Independence Blue Cross (of Pennsylva- We identified 4,639 patients who had undergone nia), Wellmark BCBS of Iowa and Wellmark BCBS of RYGB surgery and met the criteria for the treatment South Dakota. All individuals with 1 of these 7 plans as group as well as a matched control group (table 1). primary insurer were eligible for inclusion in the data set. Females outnumbered males 5-to-1 and the majority The claims data used in this study were de-identified in (64%) of subjects were 35 to 54 years old. An upper accordance with the Health Insurance Portability and Ac- urinary tract calculus was diagnosed in 355 subjects countability Act of 1996 definition of a limited data set and (7.65%) in the bariatric surgery group compared to 215 were used in accordance with federal standards for pro- (4.63%) in the comparison cohort (p Ͻ0.0001). Mean tecting the confidentiality of the personal health informa- time from RYGB to diagnosis of an upper tract calcu- tion of the enrollee. The institutional review board of The lus was 558.65 days. In the subsample who experi- Johns Hopkins University found this analysis to be ex- empt from the requirement for review. The data set in- enced kidney stone events subjects who underwent cludes approximately 2.4 million insured lives during a RYGB were not more likely to have experienced mul- 5-year period (2002 to 2006) with information on enrollee tiple stone events than those in the control cohort (OR age, sex, enrollment dates and claims for reimbursement 1.03, 95% CI 0.736–1.437, p ϭ 0.871). for billable health care services. Included in these data are Of the bariatric surgery cohort 3.30% (153 of patient diagnoses as identified by ICD-9 codes and Diag- 4,639) underwent a urological procedure for an up- nosis Related Groups, and medical procedures classified per urinary tract calculus in the 3 years after bari- by CPT codes and ICD-9 procedure codes. atric surgery vs 0.93% (43 of 4,639) of the compari- Subjects undergoing RYGB surgery with enrollment son group (p Ͻ0.0001) (table 2). Ureteroscopy and for 3 years following the date of bariatric surgery were shock wave lithotripsy were used to a similar extent selected for the treatment group. The codes used to define whereas nephrolithotomy was relied on less com- these procedures are found in Appendix 1. There were 18 patients with cancers of the esophagus, stomach, small monly.
Load more

Recommended publications
  • Bariatric Surgery and Kidney-Related Outcomes
    WORLD KIDNEY DAY MINI SYMPOSIUM ON KIDNEY DISEASE AND OBESITY Bariatric Surgery and Kidney-Related Outcomes Alex R. Chang1,2, Morgan E. Grams3,4 and Sankar D. Navaneethan5,6 1Kidney Health Research Institute, Geisinger Health System, Danville, Pennsylvania, USA; 2Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, Pennsylvania, USA; 3Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA; 4Divison of Nephrology, Johns Hopkins Uni- versity, Baltimore, Maryland, USA; 5Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; and 6Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA The prevalence of severe obesity in both the general and the chronic kidney disease (CKD) populations continues to rise, with more than one-fifth of CKD patients in the United States having a body mass index of $35 kg/m2. Severe obesity has significant renal consequences, including increased risk of end-stage renal disease (ESRD) and nephrolithiasis. Bariatric surgery represents an effective method for achieving sustained weight loss, and evidence from randomized controlled trials suggests that bariatric surgery is also effective in improving blood pressure, reducing hyperglycemia, and even inducing diabetes remis- sion. There is also observational evidence suggesting that bariatric surgery may diminish the long-term risk of kidney function decline and ESRD. Bariatric surgery appears to be relatively safe in patients with CKD, with postoperative complications only slightly higher than in the general bariatric surgery popula- tion. The use of bariatric surgery in patients with CKD might help prevent progression to ESRD or enable selected ESRD patients with severe obesity to become candidates for kidney transplantation.
    [Show full text]
  • Technic VERTICAL GASTROPLASTY WITH
    ABCDDV/802 ABCD Arq Bras Cir Dig Technic 2011;24(3): 242-245 VERTICAL GASTROPLASTY WITH JEJUNOILEAL BYPASS - NEW TECHNICAL PROCEDURE Gastroplastia vertical com desvio jejunoileal - novo procedimento técnico Bruno ZILBERSTEIN, Arthur Sergio da SILVEIRA-FILHO, Juliana Abbud FERREIRA, Marnay Helbo de CARVALHO, Cely BUSSONS, Henrique JOAQUIM, Fernando RAMOS From Gastromed-Instituto Zilberstein, São ABSTRACT - Introduction - Vertical gastroplasty is increasingly used in the surgical Paulo, SP, Brasil. treatment of morbid obesity, being used alone or as part of the duodenal switch surgery or even in intestinal bipartition (Santoro technique). When used alone has only a restrictive character. Method - Is proposed association of jejunoileal bypass to vertical gastroplasty, in order to give a metabolic component to the procedure and eventually empower it to medium and long term. Eight morbidly obese patients were operated after removal of adjustable gastric band or as a primary procedure associated to vertical banded gastroplasty with jejunoileal bypass laterolateral and anastomosis between the jejunum 80 cm from duodenojejunal angle and the ileum at 120 cm from ileocecal valve, by laparoscopy. Results - The patients presented themselves without complications both in trans or in the immediate postoperative period, and also in the months that followed. The evolution BMI showed a significant reduction ranging from 39.57 kg/m2 to 28 kg/m2. No patient reported diarrhea or malabsorptive disorder in HEADINGS - Sleeve gastrectomy. Jejunoileal the period. Conclusion - It can be offered a new therapeutic option, with restraining diversion. Obesity. Surgery. and metabolic aspects, in which there are no consequences as the ones founded in procedures with duodenal diversion or intestinal transit alterations.
    [Show full text]
  • Immunoelectrophoretic Studies on Human Small
    Gut: first published as 10.1136/gut.21.8.662 on 1 August 1980. Downloaded from Gut, 1980, 21, 662-668 Immunoelectrophoretic studies on human small intestinal brush border proteins: cellular alterations in the levels of brush border enzymes after jejunoileal bypass operation H SKOVBJERG, E GUDMAND-H0YER, 0 NOREN, AND H SJOSTROM From the Department ofBiochemistry C, The Panum Institute, Medical-gastroenterological Department C, and Surgical-gastroenterological Department D, Herlev Hospital, University of Copenhagen, Denmark SUMMARY The amounts of lactase (EC 3.2.1.23), sucrase (EC 3.2.1.48), maltase (EC 3.2.1.20), microvillus aminopeptidase (microsomal EC 3.4.11.2), and dipeptidyl peptidase IV (EC 3.4.14. x) in biopsies from proximal jejunum and distal ileum were studied by quantitative crossed immuno- electrophoresis and enzymatic assays in obese patients one and six months after jejunoileal bypass operation and compared with peroperative levels. They were related to DNA and protein content. The protein/DNA ratio fell 28-43 % postoperatively. Except for ileal lactase and sucrase all enzymes showed decreased levels when expressed per mg protein and an even more pronounced decrease when related to DNA. Lactase and sucrase levels in ileum were increased or unchanged. A constant correlation between the amount of immunoreactive enzyme protein and enzymatic activity was shown for all enzymes except maltase. The results suggest that the bypass operation is followed http://gut.bmj.com/ by an increased amount of enterocytes devoid of or low in enzymatic activity and protein content. The amounts of lactase and sucrase in ileum are increased in relation to the other enzymes.
    [Show full text]
  • Hepatic Complications of Bariatric Surgery : the Reverse Side of the Coin
    REVIEW 505 Hepatic complications of bariatric surgery : the reverse side of the coin U. Vespasiani-Gentilucci*1, F. Vorini*1, S. Carotti2, A. De Vincentis1, G. Galati1, P. Gallo1, N. Scopinaro3, A. Picardi1 (1) Internal Medicine and Hepatology Unit ; (2) Laboratory of Microscopic and Ultrastructural Anatomy, CIR ; University Campus Bio-Medico of Rome, Italy; (3) Department of Surgery, Ospedale San Martino, University of Genoa, Italy. Abstract Indeed, several studies demonstrated an association between weight loss and regression of nonalcoholic fatty Background : Even if the jejunoileal bypass has been definitely abandoned due to the high rate of hepatic complications, cases of liver disease (NAFLD) and non-alcoholic steatohepatitis liver injury after the new bariatric procedures are still reported. We (NASH) (5,9-11), and others proved a significant rate of aimed to review the available literature concerning liver damage fibrosis – and even cirrhosis – regression after bariatric associated with the older and newer types of bariatric surgeries. Methods : An extensive literature search of MEDLINE was surgery (12). On the other side, from the middle ’70s, performed using different combinations of the following terms: several reports have focused on the high rate of hepatic “bariatric surgery OR biliopancreatic diversion OR jejunoileal complications following the first widely diffused bariatric bypass OR roux-en-y gastric bypass OR vertical banded gastro- plasty OR laparoscopic adjustable gastric banding” AND “hepatic/ technique, the jejunoileal
    [Show full text]
  • A History of Bariatric Surgery the Maturation of a Medical Discipline
    A History of Bariatric Surgery The Maturation of a Medical Discipline Adam C. Celio, MD, Walter J. Pories, MD* KEYWORDS Bariatric Obesity Metabolic surgery Intestinal bypass Gastric bypass Gastric sleeve Gastric band Gastric balloon KEY POINTS The history of bariatric surgery, one of the great medical advances of the last century, again documents that science progresses not as a single idea by one person, but rather in small collaborative steps that take decades to accept. Bariatric surgery, now renamed “metabolic surgery,” has, for the first time, provided cure for some of the most deadly diseases, including type 2 diabetes, hypertension, severe obesity, NASH, and hyperlipidemias, among others, that were previously considered incurable and for which there were no effective therapies. With organization, a common database, and certification of centers of excellence, bariat- ric surgery, once one of the most dangerous operations, is now performed throughout the United States with the same safety as a routine cholecystectomy. RECOGNITION Obesity is now a worldwide public health problem, an epidemic, with increasing inci- dence and prevalence, high costs, and associated comorbidities.1 Although the genes from our ancestors were helpful in times of potential famine, now in times of plenty, they have contributed to obesity.1–4 The history of obesity is related to the history of food; the human diet has changed considerably over the last 700,000 years. Our an- cestors at one time were hunter-gatherers, consuming large and small game along with nuts and berries. Their diets were high in protein and their way of life was stren- uous; they were well suited for times of famine.
    [Show full text]
  • Incidence and Risk Factors for Cholelithiasis After Bariatric Surgery
    Obesity Surgery (2019) 29:2110–2114 https://doi.org/10.1007/s11695-019-03760-4 ORIGINAL CONTRIBUTIONS Incidence and Risk Factors for Cholelithiasis After Bariatric Surgery Hernán M. Guzmán1 & Matías Sepúlveda1,2 & Nicolás Rosso 3 & Andrés San Martin2 & Felipe Guzmán4 & Hernán C. Guzmán1,2 Published online: 17 April 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Background Obesity and rapid weight loss after bariatric surgery (BS) are independent risk factors for development of choleli- thiasis (CL), a prevalent disease in the Chilean population. This study aimed to determine the incidence of CL in obese Chilean patients 12 months after BS and identify risk factors for development of gallstones. Methods Retrospective study of patients who underwent BS in 2014. Patients with preoperative negative abdominal ultrasound (US) for CL and follow-up for at least than 12 months were included. Patients underwent US at 6 months and 12 months. We analyzed sex, age, hypertension, dyslipidemia, type 2 diabetes mellitus, body mass index (BMI), surgical procedure, percentage of excess BMI loss (%EBMIL) at 6 months, and BMI at 6 months. Results Of 279 patients who underwent bariatric surgery during 2014, 66 had previous gallbladder disease and 176 met the inclusion criteria (82.6%), while 54.6% were female. The mean age was 37.8 ± 10.5 years and preoperative BMI was 37.5 kg/m2. BMI and %EBMIL at 6 months were 27.8 ± 3.3 kg/m2 and 77.9 ± 33.6%, respectively. At 12 months after BS, CL was found in 65 patients (36.9%). Hypertension turned out to be protective against occurrence of gallstones at 1 year with an OR 0.241.
    [Show full text]
  • Colon Adenocarcinoma After Jejunoileal Bypass for Morbid Obesity Lee Morris1,*, Ilimbek Beketaev1, Roberto Barrios2, and Patrick Reardon1
    Journal of Surgical Case Reports, 2017;11, 1–4 doi: 10.1093/jscr/rjx214 Case Report CASE REPORT Colon adenocarcinoma after jejunoileal bypass for morbid obesity Lee Morris1,*, Ilimbek Beketaev1, Roberto Barrios2, and Patrick Reardon1 1Department of Surgery, Houston Methodist, Houston, TX, USA and 2Department of Pathology and Genomic Medicine, Houston Methodist, Houston, TX, USA *Correspondence address: Department of Surgery, Houston Methodist, 6550 Fannin Street, Suite 2435, Houston, TX 77030, USA. Tel: +1-713-790-3140; Fax: +1-713-790-3235; E-mail: [email protected] Abstract Jejunoileal bypass (JIB) was developed as a surgical treatment for morbid obesity in the early 1950s. However, this procedure is now known to be associated with multiple metabolic complications and has subsequently been abandoned as a viable bariatric procedure. Some of these known complications include renal stone formation, liver failure, migratory arthritis, fat- soluble deficiencies, blind-loop syndrome and severe diarrhea. Additionally, there have been animal models suggesting colon dysplasia after JIB. To our knowledge however, in humans, no colon cancers have been attributed to JIB in the litera- ture. Here we report a 63-year-old morbidly obese female who had a JIB surgery in 1973 and subsequently was found to have numerous sessile colonic polyps throughout her colon and adenocarcinoma of the ascending colon without any family his- tory of colonic polyposis syndromes or colon cancer. INTRODUCTION our best knowledge, the first case of a colon adenocarcinoma following JIB surgery in humans. Bariatric surgery has proven to be the most efficacious treat- ment for morbid obesity and resolution of obesity-related comorbidities [1].
    [Show full text]
  • Nutritional Markers Following Duodenal Switch for Morbid Obesity
    Obesity Surgery, 14, pp-pp Nutritional Markers following Duodenal Switch for Morbid Obesity Robert A. Rabkin MD, FACS; John M. Rabkin, MD, FACS; Barbara Metcalf, RN; Myra Lazo, MS, PA-C; Michael Rossi, PA-C; Lee B. Lehman- Becker, BA Pacific Laparoscopy, San Francisco, CA, USA Background: Laparoscopic duodenal switch with gas- Introduction tric reduction (LapDS) is a minimally invasive hybrid operation combining moderate intake restriction with moderate malabsorption for treatment of morbid obe- The duodenal switch (DS) was first performed by sity. In LapDS, both the quantity of food ingested and Hess 19881 and Marceau et al2 in 1990, and a the efficiency of digestion are reduced. laparoscopic approach (LapDS) was first imple- Methods: A cohort of 589 sequential LapDS mented by the author in 1999.3,4 The DS combines patients had laboratory studies drawn annually. Serum markers for calcium, iron and protein metabo- moderate malabsorption with moderate restriction lism and for hepatic function were analyzed using via reduced stomach capacity, yet preserves normal SAS statistical software. stomach functioning. While quality of life is diffi- Results: There were 95 men and 494 women. Mean cult to study, most postoperative patients report that age was 44 years, mean BMI 50 kg/m2 and mean pre- they continue to be able to ingest normally and operative weight 142 kg. Although mean hemoglobin enjoy eating. decreased below reference and mean parathyroid hormone (PTH) increased above reference, similar to The DS and the LapDS are identical in internal abnormal values reported after Roux-en-y gastric anatomy and are fashioned as shown in Figure 1.
    [Show full text]
  • Technique SADI-S with RIGHT GASTRIC ARTERY LIGATION
    ABCDDV/1211 ABCD Arq Bras Cir Dig Original Article – Technique 2016;29(Supl.1):85-90 DOI: /10.1590/0102-6720201600S10021 SADI-S WITH RIGHT GASTRIC ARTERY LIGATION: TECHNICAL SYSTEMATIZATION AND EARLY RESULTS SADI-S com ligadura da artéria gástrica: sistematização técnica e os primeiros resultados Jordi Pujol GEBELLI1, Amador Garcia Ruiz de GORDEJUELA1, Almino Cardoso RAMOS2, Mario NORA3, Ana Marta PEREIRA3, Josemberg Marins CAMPOS4, Manoela Galvão RAMOS2, Eduardo Lemos de Souza BASTOS2, João Batista MARCHESINI5 From the1Hospital Universitari de Bellvitge, ABSTRACT –Background: Bariatric surgery is performed all over the world with close to 500.000 Barcelona, Spain; 2Gastro-Obeso-Center procedures per year. The most performed techniques are Roux-en-Y gastric bypass and Advanced Surgical Institute, São Paulo, sleeve gastrectomy. Despite this data, the most effective procedure, biliopancreatic diversion Brazil; 3Centro Hospitalar Entre Douro with or without duodenal switch, represents only no more than 1.5% of the procedures. e Vouga, Portugal; 4Federal University Technical complexity, morbidity, mortality, and severe nutritional adverse effects related to of Pernambuco, Recife, Brazil; 5Clínica the procedure are the main fears that prevent most universal acceptance. Aim: To explain Marchesini, Curitiba, PR, Brazil the technical aspects and the benefits of the SADI-S with right gastric artery ligation as an effective simplification from the original duodenal switch.Methods : Were included all patients undergoing this procedure from the November 2014 to May 2016, describing and analysing aspects of this technique, the systematization and early complications associated with the procedure. Results: A series of 67 patients were operated; 46 were women (68.7%); mean age of the group was 44 years old (33-56); and an average BMI of 53.5 kg/m2 (50-63.5).
    [Show full text]
  • Rectal Hyperplasia After Jejunoileal Bypass for Morbid Obesity
    Gut: first published as 10.1136/gut.29.11.1544 on 1 November 1988. Downloaded from Gut, 1988, 29, 1544-1548 Rectal hyperplasia after jejunoileal bypass for morbid obesity G VN APPLETON, E E WHEELER, R AL-MUFTI, D N CHALLACOMBE, AND R C N WILLIAMSON From the University Department ofSurgery, Bristol Royal Infirmary and Somerset Children's Research Unit, Musgrove Park Hospital, Taunton, Somerset SUMMARY Jejunoileal bypass (JIB) has been widely used to treat patients with morbid obesity for the past 20 years. In rats JIB causes adaptive colonic hyperplasia and enhances colorectal neoplasia. In this study crypt cell production rate (CCPR) was measured stathmokinetically in cultured rectal biopsies from nine patients with JIB and seven controls without intestinal operations or disease. Crypt cell production rate in the group with JIB was more than double that ofcontrols (12.80 (2.67) v 6.23 (1.49) cells/crypt/h: p<0001). There were no significant differences in crypt morphometry and histological examination of rectal biopsies was normal. Patients with JIB have a marked and persistent increase in cell proliferation in the large intestine and may be at increased risk of developing colonic cancer. http://gut.bmj.com/ During the 20 years since jejunoileal bypass (JIB) Methods was introduced for the treatment of morbid obesity,' it is estimated that over 100 000 such operations have PATIENTS AND BIOPSIES been carried out in the USA alone.2 In rats, end-to- Nine patients were studied from among those who side JIB stimulates adaptive growth and enhances had undergone JIB for morbid obesity in Bristol over chemical carcinogenesis in the colon,3 although the last 11 years.
    [Show full text]
  • Surgery for Type 2 Diabetes: a Personal Perspective Review Diabetes Care 2019;42:331–340 |
    Diabetes Care Volume 42, February 2019 331 Metabolic (Bariatric and Henry Buchwald1,2 and Jane N. Buchwald3 Nonbariatric) Surgery for Type 2 Diabetes: A Personal Perspective Review Diabetes Care 2019;42:331–340 | https://doi.org/10.2337/dc17-2654 Metabolic surgery can cause amelioration, resolution, and possible cure of type 2 diabetes. Bariatric surgery is metabolic surgery. In the future, there will be metabolic surgery operations to treat type 2 diabetes that are not focused on weight loss. These procedures will rely on neurohormonal modulation related to the gut as well as outside the peritoneal cavity. Metabolic procedures are and will always be in flux as surgeons seek the safest and most effective operative modality; there is no enduring gold standard operation. Metabolic bariatric surgery for type 2 diabetes is more than part of the clinical armamentarium, it is an invitation to perform basic research and to achieve fundamental scientific REVIEW knowledge. And the Lord God caused a deep sleep to fall upon Adam, and he slept; and he took one of his ribs, and closed up the flesh instead thereof, and the rib which the Lord had taken from man, made he a woman.... dGenesis 2:21-22 METABOLIC SURGERY In 1978, in the foreword to the book Metabolic Surgery (1), by author H.B. and Richard L. Varco, we defined the discipline of metabolic surgery “as the operative manipu- 1Department of Surgery, University of Minne- sota, Minneapolis, MN lation of a normal organ or organ system to achieve a biological result for a potential 2 ” “ ” Department of Biomedical Engineering, Univer- health gain.
    [Show full text]
  • Jejuno-Ileal Bypass Arthropathy: Its Clinical Features and Associations J
    Ann Rheum Dis: first published as 10.1136/ard.42.5.553 on 1 October 1983. Downloaded from Annals of the Rheumatic Diseases, 1983, 42, 553-557 Jejuno-ileal bypass arthropathy: its clinical features and associations J. P. DELAMERE,1 R. M. BADDELEY,2 AND K. W. WALTON1 From the 'Department of Investigative Pathology, the Medical School, Birmingham, and the 2Department of Surgery, General Hospital, Birmingham SUMMARY Postoperative arthropathy has been reported in patients undergoing jejunoileal bypass for morbid obesity. The true frequency of this complication, and its independence from pre- existing joint disease and from osteomalacia, have not been clearly established. Of 107 patients who had undergone jejunoileal bypass, and in whom osteomalacia had been excluded, 38 developed a distinctive arthropathy. This consisted of episodic polyarthralgia, and occasionally arthritis, affecting both large and small joints. The articular symptom complex was independent of other major postoperative complications and unrelated to metabolic disturbances consequent upon rapid weight reduction. Preoperative joint symptoms had a similar incidence in those who did and in those who did not subsequently develop the postoperative arthropathy. Reversal of the intestinal bypass was always associated with an immediate, complete, and permanent remission of arthropathic symptoms. copyright. The surgical management of morbid obesity by the bowel pathology and arthritis1" highlights the impor- induction of an intestinal bypass was pioneered by tance of ascertaining whether a definite complex of Payne et al.,' beginning in 1956, after the failure of musculoskeletal symptoms and signs, independent of medical treatment in some patients to procure and other metabolic complications, develops as a conse- maintain satisfactory weight reduction.
    [Show full text]