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Bariatric surgery and secondary hyperparathyroidism: a meta-analysis

  • Author Footnotes
    ∗ Zixin Cai and Qirui Zhang contributed equally to this work.
    Zixin Cai
    Footnotes
    ∗ Zixin Cai and Qirui Zhang contributed equally to this work.
    Affiliations
    National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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  • Author Footnotes
    ∗ Zixin Cai and Qirui Zhang contributed equally to this work.
    Qirui Zhang
    Footnotes
    ∗ Zixin Cai and Qirui Zhang contributed equally to this work.
    Affiliations
    Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China

    Department of Biliopancreatic and Metabolic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
    Search for articles by this author
  • Yingling Jiang
    Affiliations
    Department of Metabolism and Endocrinology, Zhuzhou Central Hospital/Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan, China
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  • Jingjing Zhang
    Correspondence
    Jingjing Zhang, National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
    Affiliations
    National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
    Search for articles by this author
  • Wei Liu
    Correspondence
    Correspondence: Wei Liu, M.B.B.S., Ph.D. Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Department of Biliopancreatic and Metabolic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
    Affiliations
    Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China

    Department of Biliopancreatic and Metabolic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
    Search for articles by this author
  • Author Footnotes
    ∗ Zixin Cai and Qirui Zhang contributed equally to this work.
Published:September 22, 2022DOI:https://doi.org/10.1016/j.soard.2022.09.013

      Highlights

      • The present meta-analysis is the first quantitative summary of the effect of metabolic and bariatric surgery on secondary hyperparathyroidism risk and includes a large sample size of patients.
      • In addition to comparing the impact of metabolic and bariatric surgery on secondary hyperparathyroidism, this meta-analysis compared the impact of follow-up time and surgical procedure on secondary hyperparathyroidism.
      • However, owing to the retrospective nature and low quality of this study, the direction of the causality is hard to determine.

      Abstract

      Background

      Obesity increases the risk of obesity-related medical problems. Weight loss after metabolic and bariatric surgery (MBS) has been well studied. However, the effects of MBS on parathyroid function remain unclear.

      Objective

      The objective of this study was to perform a meta-analysis to examine the impact of MBS on the risk of secondary hyperparathyroidism (SHPT).

      Setting

      The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.

      Methods

      The PubMed, Embase, Web of Science, and the Cochrane Library databases were systematically reviewed from inception to May 2022 to identify studies reporting quantitative measurements of SHPT risk pre-MBS and post-MBS. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were estimated and compared. Effects were pooled using a random-effects or fixed-effects model. Subgroup analyses were performed according to the follow-up time and surgical procedure.

      Results

      The final meta-analysis included 9 studies with a total of 5585 patients. The mean follow-up time was 3.5 years (range 0.25–5). Overall, MBS appears to does not affect SHPT risk (OR = 1.34, 95% CI 0.81–2.20, I2 = 95%). Follow-up data showed no evidence of SHPT within 2 years following gastric bypass (GB) and sleeve gastrectomy procedures (OR = 1.42, 95% CI 0.66–3.07 for GB, OR = 0.39, 95% CI 0.09–1.62 for sleeve gastrectomy ). At the 2-year and long-term follow-up intervals, a marked increase in SHPT was detected for GB (OR = 6.06, 95% CI 3.39–10.85 for GB). In addition, the surgical procedure for GB decreased the likelihood of SHPT compared with the surgical procedure for biliopancreatic diversion with duodenal switch (OR = 0.29, 95% CI 0.17–0.49).

      Conclusions

      Our meta-analysis indicated that GB appears to increase SHPT risk. Patients undergoing MBS should be aware of the risk of SHPT. Larger studies are needed to evaluate the outcomes and side effects and may eventually provide a better and more comprehensive understanding of the risks.

      Keywords

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      Linked Article

      • Comment on: Bariatric surgery and secondary hyperparathyroidism: a meta-analysis
        Surgery for Obesity and Related DiseasesVol. 19Issue 1
        • Preview
          I thank Cai et al. [1] for their excellent meta-analysis addressing the important topic of secondary hyperparathyroidism and metabolic and bariatric surgery (MBS). This meta-analysis represents the first quantitative summary of the effect of MBS on secondary hyperparathyroidism (SHPT) risk and includes a large sample size of patients. This meta-analysis included a total of 5585 patients from 9 studies with a mean follow-up time of 3.5 years (range, .25–5). In addition to comparing the impact of MBS on SHPT, this meta-analysis compared the impact of follow-up time and surgical procedure on SHPT.
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      • Comment on: Bariatric surgery and secondary hyperparathyroidism: a meta-analysis
        Surgery for Obesity and Related DiseasesVol. 19Issue 1
        • Preview
          I was recently asked by a younger bariatric surgeon why a general surgeon with no formal bariatric fellowship training was allowed to perform laparoscopic sleeve gastrostomies in her town. I explained that there are many bariatric surgeons in our great subspeciality who either were grandfathered into their career path before minimally invasive fellowships were in existence or perfected their bariatric skill sets by other means outside of a formal fellowship training paradigm. These options are perfectly acceptable within the confines and standards set forth in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program [1].
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