Result of a National Audit of Bariatric Surgery Performed at Academic Centers

Nguyen, Ninh T.; Silver, Michael; Robinson, Malcolm K.; Needleman, Bradley J.; Hartley, Guilford G.; Cooney, Robert N.; Catalano, Robert B.; Dostal, Jackie; Sama, Danny; Blankenship, Jeanne; Burg, Kathryn; Stemmer, Edward A.; Wilson, Samuel E.; Schwesinger, Wayne H.; DeBord, James R.; Stellato, Thomas A.; Moonka, Ravi

doi:10.1001/archsurg.141.5.445

Cited by 112 publications

(55 citation statements)

References 21 publications

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“…In a multi-institutional consecutive cohort study of 1144 bariatric surgeries, RYGB was performed in 1049 (91.7%) cases (8). RYGB is both a gastric restrictive and a malabsorptive operation.…”

Section: Discussionmentioning

confidence: 99%

“…RYGB is currently the most common bariatric surgery in the United States because of its high success rate in weight reduction (8). In one study with Ͼ5 yr of follow-up, successful outcomes (weight reduction to body mass index [BMI] Յ35 kg/m 2 or loss of excess weight Ͼ50%) were achieved in 93% of obese (BMI 36 to 39 kg/m 2 ) or morbidly obese (BMI 40 to 49 kg/m 2 ) patients and in 57% of superobese (BMI Ͼ50 kg/m 2 ) patients (9).…”

mentioning

confidence: 99%

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Oxalate Nephropathy Complicating Roux-en-Y Gastric Bypass

Nasr

D’Agati

Said

et al. 2008

Clinical Journal of the American Society of Nephrology

183

143

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Background and objectives: The most common bariatric surgery is Roux-en-Y gastric bypass (RYGB), which has been associated with hyperoxaluria and nephrolithiasis. We report a novel association of RYGB with renal insufficiency as a result of oxalate nephropathy.Design, setting, participants, & measurements: Eleven cases of oxalate nephropathy after RYGB were identified from the Renal Pathology Laboratory of Columbia University. The clinical features, pathologic findings, and outcomes are described.Results: Patients were predominantly white (72.7%) with a mean age of 61.3 yr. Indications for RYGB included morbid obesity (eight patients) and reconstruction after total gastrectomy for gastric cancer (three patients). All 11 patients had a history of hypertension, and 9 were diabetic. Patients presented with acute renal failure, often superimposed on mild chronic renal insufficiency (n ‫؍‬ 7), at a median of 12 mo after RYGB. The mean creatinine at baseline, at discovery of acute renal failure, and at biopsy was 1.5, 5.0, and 6.5 mg/dl, respectively. Renal biopsies revealed diffuse tubular degenerative changes, abundant tubular calcium oxalate deposits, and varying degrees of tubulointerstitial scarring. In addition, seven biopsies had underlying diabetic glomerulosclerosis and two had glomerulosclerosis attributable to obesity and hypertension. Eight of 11 patients rapidly progressed to ESRD and required hemodialysis at a mean of 3.2 wk after renal biopsy. The remaining three patients were left with significant chronic kidney disease.Conclusions: Oxalate nephropathy is an underrecognized complication of RYGB and typically results in rapid progression to ESRD. Patients with pre-existing renal disease may be at higher risk for this complication.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Oxalate Nephropathy Complicating Roux-en-Y Gastric Bypass

Nasr

D’Agati

Said

et al. 2008

Clinical Journal of the American Society of Nephrology

183

143

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“…< 30 d and late complications, seen after the first 30 d. Total post-surgical complications or adverse effects following a gastric bypass can be as high as 16% (11) (see Table 2 for surgical complications that may result in nutritional consequences). The complications that are likely to be present early are anastomotic leaks, haemorrhages, fistulas and perforations, whereas anastomotic strictures, bowel obstructions and band erosions are more likely to occur after the first 30 d (2,(11)(12)(13)(14) . Anastomotic leaks are the most common gastrointestinal complication occurring in 2-5% of laparoscopic gastric bypass cases (11)(12)(13)(14) .…”

Section: Complications Following Bariatric Surgerymentioning

confidence: 99%

“…The complications that are likely to be present early are anastomotic leaks, haemorrhages, fistulas and perforations, whereas anastomotic strictures, bowel obstructions and band erosions are more likely to occur after the first 30 d (2,(11)(12)(13)(14) . Anastomotic leaks are the most common gastrointestinal complication occurring in 2-5% of laparoscopic gastric bypass cases (11)(12)(13)(14) . Kumpf and co-workers (15) in their survey of nutritional practices with complications postbariatric surgery reported anastomotic leaks as the most common indication for nutrition support.…”

Section: Complications Following Bariatric Surgerymentioning

confidence: 99%

“…Adjusted body weight has been proposed, on Table 2. Post-operative complications that result in nutritional consequences (2,(11)(12)(13)(14) Complications Observed with this procedure the assumption that the obese have a lean body mass that equates to 25% more than that of the non-obese. This is not a validated method and does not take into consideration the variations in body compositions.…”

Section: Estimated Nutritional Requirementsmentioning

confidence: 99%

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Provision of nutritional support to those experiencing complications following bariatric surgery

Segaran

2010

Proc. Nutr. Soc.

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This review details the practicalities of providing nutrition support to obese patients who experience complications following bariatric surgery and highlights some of the nutritional challenges encountered by this group of patients. Bariatric surgery to treat morbid obesity has significantly increased internationally over the past decade with hospital admissions rising annually. The gastric bypass is currently the most commonly performed procedure. The complication rate can be up to 16%, with a considerable proportion having nutritional implications. The treatment can involve avoidance of oral diet and nutrition support, i.e. enteral or parenteral nutrition. Opposition to nutrition support can be encountered. It is useful to clarify the aims of nutrition support, these being: the avoidance of overfeeding and its consequences, preservation of lean body mass and promotion of healing. Evidence suggests that hypoenergic nutrition is not harmful and may actually be beneficial. There is a lack of consensus regarding the optimum method to predict the nutritional requirements in the obese acutely unwell patient. The literature suggests that the predicted equations are fairly accurate compared to measured energy expenditure in free living obese patients before and after bariatric surgery. However, these findings cannot be directly applied to those obese patients experiencing complications of bariatric surgery, who will be acutely unwell exhibiting inflammatory response. It is therefore necessary to refer to the literature on energy expenditure in hospitalized obese patients, to help guide practice. More research examining the energy and protein requirements of obese patients needing nutrition support following bariatric surgery is urgently required.

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