Pre Resection Gastric Bypass Reduces Post Resection BMI but Not Liver Disease in Short Bowel Syndrome
Jon Thompson*, Rebecca a. Weseman, Fedja a. Rochling, Wendy J. Grant, Jean Botha, Alan Langnas, David F. Mercer
Surgery, University Nebraska Medical Center, Omaha, NE
Abstract: Patients who develop short bowel syndrome (SBS) while morbidly obese maintain a higher BMI and are more likely to develop hepatobiliary complications than non-obese patients. The mechanisms for these findings are unknown. Our aim was to determine the effect of pre resection gastric bypass (GBP) on postresection BMI and the incidence of liver disease in SBS patients.
Methods: We reviewed 100 adult patients with SBS: 55 patients with initial BMI <35 were controls; 28 patients with initial BMI >35 were the obese group; and 17 patients had undergone GBP prior to SBS.
Results: There were no differences in age, gender, or intestinal anatomy. Obese patients were more likely to weaned off PN (44% vs25% control and 12% GBP, p<.05). Overall 38% of patients have undergone ostomy closure, intestinal lengthening and intestinal transplantation with a similar occurrence in all groups 11 (68%) of the GBP patients had gastric continuity reestablished. Pre resection BMI in controls was significantly lower than obese and GBP groups (26 vs 43 and 37). BMI at 1, 2, and 5 years was similar in control and GBP groups (23, 23, and 23 versus 23 24 and 26). Obese patients had a persistently increased BMI (37, 32, and 32 at 1, 2, and 5 years). % IBW trends were similar. 7 (41%) of the GBP patients had a pre resection BMI >35. BMI and %IBW were similar at 1,2, and 5 years in those GBP patients with BMI >35 and those <35 (26, 26, and 26 vs 22, 20, and 26).Cholelithiasis and cirrhosis occurred to a similar extent in all 3 groups. Radiographic fatty liver tended to be higher in the GBP group (41% vs 16% controls and 32% obese groups). End stage liver disease occurred only in patients on PN >1 year and tended to be higher in obese and GBP patients compared to controls (33% and 33% vs 17%).
Conclusions: GBP prevents the nutritional benefits of obesity in SBS patients. This occurs independent of pre SBS BMI suggesting that GBP itself rather than surgically induced weight loss is the important factor. However, GBP does not appear to eliminate the increased risk of hepatobiliary disease observed in obese SBS patients.
Back to 2011 Program
