Pre-resection gastric bypass reduces post-resection body mass index but not liver disease in short bowel syndrome

Jon S Thompson; Rebecca A Weseman; Fedja A Rochling; Wendy J Grant; Jean F Botha; Alan N Langnas; David F Mercer

doi:10.1016/j.amjsurg.2013.10.019

Pre-resection gastric bypass reduces post-resection body mass index but not liver disease in short bowel syndrome

Am J Surg. 2014 Jun;207(6):942-8. doi: 10.1016/j.amjsurg.2013.10.019. Epub 2014 Jan 4.

Authors

Jon S Thompson¹, Rebecca A Weseman², Fedja A Rochling³, Wendy J Grant², Jean F Botha², Alan N Langnas², David F Mercer²

Affiliations

¹ Department of Surgery, University of Nebraska Medical Center Omaha, Omaha, NE, USA. Electronic address: jthompso@unmc.edu.
² Department of Surgery, University of Nebraska Medical Center Omaha, Omaha, NE, USA.
³ Department of Internal Medicine, University of Nebraska Medical Center Omaha, Omaha, NE, USA.

PMID: 24507944
DOI: 10.1016/j.amjsurg.2013.10.019

Abstract

Background: Obese patients developing short bowel syndrome (SBS) maintain a higher body mass index (BMI) and have increased risk of hepatobiliary complications. Our aim was to determine the effect of pre-resection gastric bypass (GBP) on SBS outcome.

Methods: We reviewed 136 adults with SBS: 69 patients with initial BMI < 35 were controls; 43 patients with BMI > 35 were the obese group; and 24 patients had undergone GBP before SBS.

Results: BMI at 1, 2, and 5 years was similar in control and GBP groups, whereas obese patients had a persistently increased BMI. Eight (33%) of the GBP patients had a pre-resection BMI > 35, but post-SBS BMI was similar to those <35. Obese patients were more likely to wean off PN (47% vs 20% control and 12% GBP, P < .05). Radiographic fatty liver tended to be higher in the GBP group (54% vs 19% control and 35% obese). End-stage liver disease occurred more frequently in obese and GBP patients (30% and 33% vs 13%, P < .05).

Conclusions: Pre-resection GBP prevents the nutritional benefits of obesity but does not eliminate the increased risk of hepatobiliary disease in obese SBS patients. This occurs independent of pre-SBS BMI suggesting the importance of GBP itself or history of obesity rather than weight loss.

Keywords: Gastric bypass; Liver disease; Obesity; Short bowel syndrome.

MeSH terms

Adult
Aged
Aged, 80 and over
Body Mass Index*
Case-Control Studies
Fatty Liver / etiology
Female
Gastric Bypass*
Humans
Liver Failure / etiology
Male
Middle Aged
Obesity, Morbid / complications*
Obesity, Morbid / surgery*
Short Bowel Syndrome / etiology*
Short Bowel Syndrome / surgery*