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Effect of preoperative metabolic profiling to reduce the risk of kidney stones after bariatric surgery in patients with a history of stone formation

Published:December 11, 2022DOI:https://doi.org/10.1016/j.soard.2022.12.023

      Highlights

      • Roux-en-Y gastric bypass (RYGB) in stone formers shows an increase in oxalate excretion in 50% of patients.
      • Sleeve gastrectomy (SG) in stone formers had no adverse effects on urinary oxalate and citrate excretion.
      • Both show favorable effects on sodium, calcium, uric acid, and phosphate excretion.
      • Metabolic profiling helps to select the best bariatric procedure in stone formers.

      Abstract

      Background

      Roux-en-Y gastric bypass (RYGB) is associated with an increased risk of kidney stone formation. This is not observed after sleeve gastrectomy (SG).

      Objectives

      Aim of this study was to assess whether preoperative metabolic profiling is helpful in selecting the most optimal bariatric procedure for patients with a kidney stone history.

      Setting

      General hospital, the Netherlands.

      Methods

      Patients with a kidney stone history and in the run up to bariatric surgery were screened with non-contrast abdominal computed tomography (CT), serum profiling, and 24-hour urine analysis. Those with stones on radiologic imaging and/or high preoperative urinary oxalate were advised to undergo SG instead of RYGB. Pre- and postoperative urine and serum profile differences between both groups were evaluated retrospectively.

      Results

      Postoperatively, RYGB (N = 28, M:F = 8:20) was associated with a 23.5% reduction in urinary volume, a 85% increase in urinary oxalate excretion with a 230% increase in calcium oxalate (CaOx) supersaturation and a 62% decrease in urinary citrate. Although SG (N = 30, M:F = 12:18) was also associated with a reduction in urinary volume, it had no adverse effects on urinary oxalate and citrate excretion, nor on calcium oxalate supersaturation (CaOx-SS). Both RYGB and SG showed favorable effects on postoperative sodium, calcium, uric acid, and phosphate excretion.

      Conclusions

      This study indicates that preoperative metabolic profiling is important to select the optimal bariatric procedure in patients with an a priori increased risk of kidney stone development. These patients should be strongly encouraged to undergo SG instead of RYGB to prevent progressive or recurrent kidney stone disease.

      Keywords

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