Abstract
BackgroundGastric bypass surgery is a highly effective therapy for long-term weight loss in severely obese patients, but carries significant perioperative risks including infection, wound dehiscence, and leaks from staple breakdown. Iron status can affect immune function and wound healing, thus may influence peri-operative complications. Common mutations in the HFE gene, the gene responsible for the iron overload disorder hereditary hemochromatosis, may impact iron status.MethodsWe analyzed 1064 extremely obese Caucasian individuals who underwent open and laparoscopic Roux-n-Y gastric bypass surgery at the Geisinger Clinic. Serum iron, ferritin, transferrin, and iron binding capacity were measured pre-operatively. All patients had intra-operative liver biopsies and were genotyped for the C282Y and H63D mutations in the HFE gene. Associations between surgical complications and serum iron measures, HFE gene status, and liver iron histology were determined.ResultsWe found that increased serum iron and transferrin saturation were present in patients with any post-operative complication, and that increased serum ferritin was also increased in patients with major complications. Increased serum transferrin saturation was also associated with wound complications in open RYGB, and transferrin saturation and ferritin with prolonged lengths of stay. The presence of 2 or more HFE mutations was associated with overall complications as well as wound complications in open RYGB. No differences were found in complication rates between those with stainable liver iron and those without.ConclusionSerum iron status and HFE genotype may be associated with complications following RYGB surgery in the extremely obese.
Highlights
Gastric bypass surgery is a highly effective therapy for long-term weight loss in severely obese patients, but carries significant perioperative risks including infection, wound dehiscence, and leaks from staple breakdown
Hepatic iron overload can be attributed to mutations in the HFE gene [9,10], the gene responsible for the iron overload disorder hereditary hemochromatosis, that cause increases in serum transferrin saturation and ferritin levels
Hepatic iron staining determined by liver biopsy obtained during Roux-en-Y gastric bypass (RYGB) surgery was noted in 17.2% patients (n = 183), while 82.8% (n = 881) of the patients studied had no evidence of increased liver iron
Summary
Gastric bypass surgery is a highly effective therapy for long-term weight loss in severely obese patients, but carries significant perioperative risks including infection, wound dehiscence, and leaks from staple breakdown. Common mutations in the HFE gene, the gene responsible for the iron overload disorder hereditary hemochromatosis, may impact iron status. Obesity and metabolic syndrome have been related to abnormalities in iron metabolism and to hepatic iron overload [1,2,3]. Iron status is commonly determined through measurement of serum iron, transferrin saturation, and ferritin levels, and through histological assessment of liver biopsies [7,8]. Hepatic iron overload can be attributed to mutations in the HFE gene [9,10], the gene responsible for the iron overload disorder hereditary hemochromatosis, that cause increases in serum transferrin saturation and ferritin levels. The C282Y mutation is less frequent but when homozygous is more often associated with iron overload. The H63D mutation is more common but far less frequently associated with iron overload. Compound C282Y/H63D heterozygotes are considered to be at risk for iron overload
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