Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Department of Urologic Surgery, University of California Davis, Sacramento, California, USA.
J Endourol. 2021 May;35(5):674-681. doi: 10.1089/end.2020.0817. Epub 2021 Jan 13.
Nephrolithiasis is common after malabsorptive bariatric surgery; however, the comparative risk of stone formation after different bariatric surgeries remains unclear. We seek to compare the risk of stone diagnosis and stone procedure after gastric banding (GB), sleeve gastrectomy (SG), short-limb Roux-en-Y (SLRY), long-limb Roux-en-Y (LLRY), and biliopancreatic diversion with duodenal switch (BPDDS). Using an administrative database, we retrospectively identified 116,304 patients in the United States, who received bariatric surgery between 2007 and 2014, did not have a known kidney stone diagnosis before surgery, and were enrolled in the database for at least 1 year before and after their bariatric surgery. We used diagnosis and procedural codes to identify comorbidities and events of interest. Our primary analysis was performed with extended Cox proportional hazards models using time to stone diagnosis and time to stone procedure as outcomes. The adjusted hazard ratio of new stone diagnosis from 1 to 36 months, compared to GB, was 4.54 for BPDDS (95% confidence interval [CI] 3.66-5.62), 2.12 for LLRY (95% CI 1.74-2.58), 2.15 for SLRY (95% CI 2.02-2.29), and 1.35 for SG (95% CI 1.25-1.46). Similar results were observed for risk of stone diagnosis from 36 to 60 months, and for risk of stone removal procedure. Male sex was associated with an overall 1.63-fold increased risk of new stone diagnosis (95% CI 1.55-1.72). BPDDS was associated with a greater risk of stone diagnosis and stone procedures than SLRY and LLRY, which were associated with a greater risk than restrictive procedures. Nephrolithiasis is more common after more malabsorptive bariatric surgeries, with a much greater risk observed after BPDDS and for male patients.
结石病在吸收不良性减肥手术后很常见；然而，不同减肥手术后结石形成的相对风险尚不清楚。我们旨在比较胃束带术（GB）、袖状胃切除术（SG）、短肠袢 Roux-en-Y（SLRY）、长肠袢 Roux-en-Y（LLRY）和胆胰分流十二指肠转位术（BPDDS）后结石诊断和结石治疗的风险。使用行政数据库，我们回顾性地确定了美国 116304 名患者，他们在 2007 年至 2014 年间接受了减肥手术，在手术前没有已知的肾结石诊断，并且在接受减肥手术之前和之后至少在数据库中登记了 1 年。我们使用诊断和程序代码来识别合并症和感兴趣的事件。我们的主要分析是使用扩展 Cox 比例风险模型，以结石诊断时间和结石治疗时间为结局。与 GB 相比，从 1 到 36 个月新结石诊断的调整后的危险比为 4.54（95%置信区间 [CI] 3.66-5.62），BPDDS 为 2.12（95%CI 1.74-2.58），LLRY 为 2.15（95%CI 2.02-2.29），SG 为 1.35（95%CI 1.25-1.46）。从 36 个月到 60 个月观察到类似的结石诊断风险，以及结石治疗风险。男性与新结石诊断的整体风险增加 1.63 倍（95%CI 1.55-1.72）相关。BPDDS 与结石诊断和结石治疗的风险高于 SRLY 和 LLRY 相关，后者与限制手术相比风险更高。结石病在更吸收不良性减肥手术后更常见，BPDDS 和男性患者观察到的风险更大。
