Saturday, March 13, 2010

Gastric bypass surgery increases risk of kidney stones, study reports

Kidney stone risk increased by gastric bypass surgery

Dallas, TX
Patients who undergo gastric bypass surgery experience changes in their urine composition that increase their risk of developing kidney stones, research from UT Southwestern Medical Center investigators suggests.

A new study, published in the March issue of The Journal of Urology, found that some of these urinary changes place weight-loss surgery patients at higher risk for developing kidney stones than obese patients who do not undergo the procedure.

For the study, researchers collected urine samples from 38 study participants. There were 16 women and three men in each of two groups. One group had undergone Roux-en-Y gastric bypass (RYGB) surgery; the second group contained normal obese individuals. RYGB, which is one of the most commonly performed weight-loss procedures, involves the creation of a small gastric pouch and allows food to bypass part of the small intestine.

The researchers found that the excretion of a material called oxalate in urine was significantly greater in the participants who had the surgical procedure than those who did not (47 percent, compared with 10.5 percent, respectively). In addition, the amount of a chemical called citrate in the urine was low in many gastric bypass patients in comparison to the obese nonsurgical group (32 percent to 5 percent).

Oxalate is found in the majority of kidney stones, while citrate inhibits stone formation.

“Almost half of the patients who had undergone gastric bypass and did not have a history of kidney stones showed high urine oxalate and low urine citrate – factors that lead to kidney-stone formation,” said Dr. Naim Maalouf, assistant professor of internal medicine in the Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and the study’s lead author.

The cause for stone formation after bariatric surgery is not entirely clear, but the study reinforces the message that weight-loss surgery patients and their physicians should be alert to the heightened risk, Dr. Maalouf said.

“These findings illustrate that the majority of patients are at risk for kidney-stone formation after RYGB,” Dr. Maalouf said. “This complication may not be well-recognized in part because it tends to occur months to years after the bypass surgery.”
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Study to examine Gastric Bypass for treatment of diabetes in non-obese patients

Gastric bypass surgery to treat diabetes in non-obese patients?

New York, NY
Patients with a body mass index below 35 generally do not qualify for weight loss surgery. But, researchers at Weill Cornell Medical Center in New York City are embarking on a new study to determine whether gastric bypass surgery can be an effective treatment for type 2 diabetes in people who are overweight but not obese.

The study aims to explore the correlation of diabetes and clinical obesity. Lead researcher Dr. Francesco Rubino notes that many people with a lower BMI can develop diabetes, and likewise, that someone who is severely obese could be diabetes free.

“For this reason alone, we need to start questioning whether BMI should be the only clinically appropriate way to decide who gets diabetes-targeted surgery,” Dr. Rubino said in a recent press statement. Diabetes affects more than 200 million people worldwide, and several studies have demonstrated that gastric bypass surgery can lead to spontaneous improvement or even resolution of the disease.

Dr. Rubino generally performs the standard Roux-en-Y bypass procedure in patients with a BMI over 35. Now, the potential benefits of the procedure are being extended to 50 non-obese patients as part of the current study.
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Thursday, March 4, 2010

Stomaphyx: Gastric bypass pouch repair

Stomaphyx a novel approach to fixing a gastric bypass pouch that has stretched

San Antonio, TX

Bariatric surgery has been a real boon for patients who need to lose massive amounts of weight. But sometimes, the small pouches created by gastric bypass procedures expand. Now, there’s a new procedure to help fix that problem.
Claudia Sisk, 51, of San Antonio lost more than 80 pounds after her original bypass surgery several years ago, but her pouch began to expand and she started regaining unwanted weight.

“Now I see myself eating a little more than usual so that’s why I went back and asked what else, was there a way they could tighten this pouch and make it smaller,” Sisk said.

“Previously, we would have to go in and operate and make incisions on the skin,” explained Dr. Mickey Seger, a bariatric surgeon. “It’s a very high risk operation. There’s over a 40% chance of having a problem or a complication with a re-do surgery like that.”

At Methodist Specialty and Transplant Hopsital, Sisk had a new procedure called Stompahyx. No cuts in the abdomen. The surgeon uses an endoscope to look down into the pouch, and a special tool to make it smaller.

Here’s how it works. The instrument is guided into the stomach. A vacuum sucks a small piece of tissue into the tube, and then the device injects a fastener into place, creating a fold in the stomach. A series of folds literally closes down the pouch, making it harder for the patient to overeat.

“It’ll dramatically reduce the amount of food she can take before being full,” Seger said. “Whereas now she can eat pretty much a regular-sized meal, we’ll be able to get her satisfied with less than a cup.”

The procedure takes less than an hour. There are no cuts and no scars. Sisk is hopeful this novel approach will be the help she needs to achieve her goal.

“Hopefully, I’ll get under 200,” Sisk stated. “I want to be, you know, 180 to 200.”

There is no big recovery with this procedure. Patients are out of the hospital within 24 hours and back to work almost immediately. The idea is that they’ll start losing weight once again.
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