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Article
August 1975

Biliary and Urinary CalculiPathogenesis Following Small Bowel Bypass for Obesity

Author Affiliations

From the Department of Surgery, Washington University School of Medicine, St. Louis.

Arch Surg. 1975;110(8):1043-1047. doi:10.1001/archsurg.1975.01360140187037
Abstract

Of 93 patients with small bowel bypass for massive exogenous obesity, three developed calcium oxalate urinary calculi, four stones in their gallbladder, and one developed both gallstones and urinary calculi during a mean follow-up period of 17.6 ± 9.0 months.

The urinary oxalate excretion increased from 21.6 to 67.8 mg/24 hours (P <.001); simultaneously, the urinary output decreased from 1,775 to 1,101 ml/24 hours (P <.001). Postoperatively, there was a significant increase in the rate of bile salt synthesis from 1.6 to 4.9 gm/day (P <.02) and in the bile salt glycine/taurine ratio from 4.6 to 6.8 (P <.05).

It is suggested that the postbypass increase in the biliary glycine/taurine ratio, with its consequent decrease in the zeta potential of the micelles in bile, is at least partly responsible for the increased incidence of cholelithiasis. The pathogenic basis for the increased incidence of urinary calculi is hyperoxaluria, which Is probably related to an increased bile salt and glycine synthesis.

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