Long-term Morbidity Following Jejunoileal Bypass

Requarth, Jay A.; Burchard, Kenneth W.; Colacchio, Thomas A.; Stukel, Thérèse A.; Mott, Leila A.; Greenberg, E. Robert; Weismann, Rodger E.

doi:10.1001/archsurg.1995.01430030088018

Cited by 130 publications

(26 citation statements)

References 63 publications

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“…The multiple complications which were associated with JIB, led to a search for alternative procedures. In 1979 [2], one type of modern bariatric surgery was gastric bypass. Full procedure gastric bypass included RYGB surgery, biliopancreatic diversion with duodenal switch, vertical banded gastroplasty, and laparoscopic adjustable gastric banding.…”

Section: Discussionmentioning

confidence: 99%

Calcium oxalate crystal related kidney injury in a patient receiving Roux-en Y hepaticojejunostomy due to gall bladder cancer

Tsai

2017

BMC Nephrol

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BackgroundCalcium oxalate nephropathy is rare in current practice. It was a common complication during jejunoileal bypass, but much less seen in modern gastric bypass surgery for morbid obesity. The major cause of it is enteric hyperoxaluria.Case presentationWe report on a patient here with acute kidney disease due to calcium oxalate nephropathy, rather than the conditions mentioned above. The male patient received a Roux-en Y hepaticojejunostomy and common bile duct drainage. In addition to enteric hyperoxaluria, chronic kidney disease related metabolic acidosis, chronic diarrhea related volume depletion, a high oxalate and low potassium diet, long term ascorbic acid intake and long term exposure to antibiotics, all predisposed him to having oxalate nephropathy.ConclusionThis is the first case with such conditions and we recommend that similarly diagnosed patients avoid all these predisposing factors, in order to avoid this rare disease and its undesired outcome.

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Section: Discussionmentioning

confidence: 99%

Calcium oxalate crystal related kidney injury in a patient receiving Roux-en Y hepaticojejunostomy due to gall bladder cancer

Tsai

2017

BMC Nephrol

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“…These procedures vary in terms of the amount of gastric surface area restriction, intended nutrient malabsorption, effects on gastrointestinal hormones, weight loss outcomes, and risk of complications (Table 1). 14 Initial efforts in bariatric surgery started in the 1970s with the jejunoileal bypass, which was a purely malabsorptive procedure, bypassing most of the small intestine 15 . The jejunoileal bypass has since been abandoned due to the high rate of complications, which included deficiency of fat-soluble vitamins, bacterial overgrowth, calcium oxalate nephrolithiasis, and kidney and liver failure.…”

Section: Overview Of Bariatric Surgery Typesmentioning

confidence: 99%

“…However, risk of kidney stones may increase after certain types of bariatric surgery and appears to be related to the degree of fat malabsorption achieved. This complication was well recognized with the jejunoileal bypass: the 15-year risk of developing renal stones was 29% 15 . Although less fat malabsorption occurs in RYGB than in the jejunoileal bypass, fecal fat has also been shown to increase 6 and 12 months after RYGB 56 .…”

Section: Overview Of Bariatric Surgery Typesmentioning

confidence: 99%

Bariatric Surgery and Kidney-Related Outcomes

Chang

Grams

Navaneethan

2017

Kidney International Reports

122

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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 remission. 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 population. 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. However, there are also renal risks in bariatric surgery, namely, acute kidney injury, nephrolithiasis, and, in rare cases, oxalate nephropathy, particularly in types of surgery involving higher degrees of malabsorption. Although bariatric surgery may improve long-term kidney outcomes, this potential benefit remains unproved and must be balanced with potential adverse events.

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“…1 RYGB was popularized to circumvent the metabolic consequences of JI bypass, including hepatic failure, severe malabsorption, nephrolithiasis and renal insufficiency. 2,3 Although it is generally safer and causes less severe malabsorption than JI bypass, RYGB still carries the risk of kidney stones, oxalate nephropathy and renal failure. 4–8 …”

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confidence: 99%

Hypocitraturia and Hyperoxaluria After Roux-en-Y Gastric Bypass Surgery

et al. 2010

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Purpose Roux-en-Y gastric bypass surgery is associated with an increased risk of nephrolithiasis but obesity itself is a known risk factor for kidney stones. To assess the mechanism(s) predisposing to nephrolithiasis after Roux-en-Y gastric bypass we compared urinary tract stone risk profiles in patients who underwent the procedure and normal obese individuals. Materials and Methods In this cross-sectional study urine and serum biochemistry was evaluated in 19 nonstone forming patients after Roux-en-Y gastric bypass and in 19 gender, age and body mass index matched obese controls without a history of nephrolithiasis. Results Compared with obese controls surgical patients had significantly higher mean ± SD urine oxalate (45 ± 21 vs 30 ± 11 mg daily, p = 0.01) and lower urine citrate (358 ± 357 vs 767 ± 307 mg daily, p <0.01). The prevalence of hyperoxaluria (47% vs 10.5%, p = 0.02) and hypocitraturia (63% vs 5%, p <0.01) was significantly higher in surgical patients, who also had significantly lower urine calcium than obese controls (115 ± 93 vs 196 ± 123 mg daily, p = 0.03). The calcium oxalate urine relative supersaturation ratio was not significantly different between the 2 groups. Conclusions Almost half of patients with Roux-en-Y gastric bypass without a history of nephrolithiasis showed hyperoxaluria or hypocitraturia. This prevalence was significantly higher than in body mass index matched controls. These risk factors were negated by lower urine calcium excretion in patients with Roux-en-Y gastric bypass.

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Long-term Morbidity Following Jejunoileal Bypass

Abstract: Jejunoileal bypass is associated with progressive accrual of serious, sometimes life-threatening complications. Lifelong follow-up for early diagnosis and surgical reversal before life is threatened should reduce the morbidity and mortality associated with this procedure.

Cited by 130 publications

References 63 publications

Calcium oxalate crystal related kidney injury in a patient receiving Roux-en Y hepaticojejunostomy due to gall bladder cancer

Calcium oxalate crystal related kidney injury in a patient receiving Roux-en Y hepaticojejunostomy due to gall bladder cancer

Bariatric Surgery and Kidney-Related Outcomes

Hypocitraturia and Hyperoxaluria After Roux-en-Y Gastric Bypass Surgery

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