title: Pre-resection gastric bypass reduces post-resection body mass index but not liver disease in short bowel syndrome.
abstract: BACKGROUND
  Obese patients developing short bowel syndrome (SBS) maintain a higher body mass index (BMI) and have increased risk of hepatobiliary complications. Our aim was to determine the effect of pre-resection gastric bypass (GBP) on SBS outcome.
  
  
  METHODS
  We reviewed 136 adults with SBS: 69 patients with initial BMI < 35 were controls; 43 patients with BMI > 35 were the obese group; and 24 patients had undergone GBP before SBS.
  
  
  RESULTS
  BMI at 1, 2, and 5 years was similar in control and GBP groups, whereas obese patients had a persistently increased BMI. Eight (33%) of the GBP patients had a pre-resection BMI > 35, but post-SBS BMI was similar to those <35. Obese patients were more likely to wean off PN (47% vs 20% control and 12% GBP, P < .05). Radiographic fatty liver tended to be higher in the GBP group (54% vs 19% control and 35% obese). End-stage liver disease occurred more frequently in obese and GBP patients (30% and 33% vs 13%, P < .05).
  
  
  CONCLUSIONS
  Pre-resection GBP prevents the nutritional benefits of obesity but does not eliminate the increased risk of hepatobiliary disease in obese SBS patients. This occurs independent of pre-SBS BMI suggesting the importance of GBP itself or history of obesity rather than weight loss.
authors: Department of Surgery, University of Nebraska Medical Center Omaha, Omaha, NE, USA. Electronic address: jthompso@unmc.edu.
authors: Jon S
authors: JS
authors: Thompson
authors: Department of Surgery, University of Nebraska Medical Center Omaha, Omaha, NE, USA.
authors: Rebecca A
authors: RA
authors: Weseman
authors: Department of Internal Medicine, University of Nebraska Medical Center Omaha, Omaha, NE, USA.
authors: Fedja A
authors: FA
authors: Rochling
authors: Department of Surgery, University of Nebraska Medical Center Omaha, Omaha, NE, USA.
authors: Wendy J
authors: WJ
authors: Grant
authors: Department of Surgery, University of Nebraska Medical Center Omaha, Omaha, NE, USA.
authors: Jean F
authors: JF
authors: Botha
authors: Department of Surgery, University of Nebraska Medical Center Omaha, Omaha, NE, USA.
authors: Alan N
authors: AN
authors: Langnas
authors: Department of Surgery, University of Nebraska Medical Center Omaha, Omaha, NE, USA.
authors: David F
authors: DF
authors: Mercer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016022:Case-Control Studies; D005234:Fatty Liver / Q000209:etiology; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D017093:Liver Failure / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*; D012778:Short Bowel Syndrome / Q000209:etiology* / Q000601:surgery*
keywords: Gastric bypass; Liver disease; Obesity; Short bowel syndrome