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Arch Surg. 2003 Aug;138(8):891-7.

The significance of elevated levels of parathyroid hormone in patients with morbid obesity before and after bariatric surgery.

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1
Department of Surgery, University of Southern California, Los Angeles, CA 90033, USA.

Abstract

HYPOTHESIS:

The risk of hyperparathyroidism after the duodenal switch operation is related to the length of the common channel.

DESIGN:

A retrospective analysis of patients following the duodenal switch operation from October 2, 2000, through February 1, 2002.

SETTING:

Academic tertiary referral hospital.

PATIENTS:

One hundred sixty-five consecutive patients underwent the duodenal switch operation, performed for morbid obesity, with common channel lengths of 75 cm (n = 103 [group A]) and 100 cm (n = 62 [group B]).

MAIN OUTCOME MEASURES:

Weight loss and parathyroid hormone, corrected calcium, and 25-hydroxyvitamin D (25-OH D) levels were compared between groups A and B. Values were determined preoperatively, early postoperatively (3-6 months), and late postoperatively (9-18 months).

RESULTS:

Both groups exhibited a slight reduction in serum calcium concentration, with one quarter decreasing below the normal range. Hyperparathyroidism was more common in group A than group B preoperatively (38.9% vs 14.9%), reflecting the higher body mass index of patients in group A. Hyperparathyroidism was also more frequent in the early (54.9% vs 30.9%) and late (49.4% vs 20.5%) postoperative periods in group A vs group B. New-onset hyperparathyroidism was also more common in group A than group B (42.0% vs 13.3%). After 1 year, subnormal 25-OH D levels were found in 17.0% of the patients in group A and in 10.0% of the patients in group B. Median 25-OH D levels increased in both groups, but tended to be higher in group B.

CONCLUSIONS:

Patients with shorter common channels had a higher risk of developing hyperparathyroidism. This may be related to limited 25-OH D absorption.

PMID:
12912749
DOI:
10.1001/archsurg.138.8.891
[Indexed for MEDLINE]
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