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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Article info
Publication history
Published online: September 22, 2022
Accepted:
September 17,
2022
Received:
March 11,
2022
Identification
Copyright
© 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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- Comment on: Bariatric surgery and secondary hyperparathyroidism: a meta-analysisSurgery for Obesity and Related DiseasesVol. 19Issue 1
- PreviewI 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-analysisSurgery for Obesity and Related DiseasesVol. 19Issue 1
- PreviewI 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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