Long-term Evolution of Nutritional Deficiencies After Gastric Bypass An Assessment According to Compliance to Medical Care

ArticleinAnnals of surgery 259(6):1104-10 · June 2014with34 Reads
DOI: 10.1097/SLA.0000000000000249 · Source: PubMed
Abstract
To study long-term nutritional deficits based on adherence to a standardized nutritional care after gastric bypass (GBP). Long-term prospective data on nutritional complications after GBP are missing. It is not known whether severe deficiencies are prevented by standard multivitamin supplementation and what parameters are influenced by patient adherence to nutritional care. One hundred forty-four consecutive subjects from our prospective database (90% women, initial body mass index: 48 ± 15 kg/m, age: 43 ± 10 years) who underwent GBP more than 3 years before the study were assessed. Multivitamins were systematically prescribed after GBP, and additional supplements were introduced if deficiencies were recorded during follow-up. We identified a group of 66 compliant subjects who attended yearly medical visits and a group of 32 noncompliant subjects who were recalled because they had not attended any visit for more than 2 years. Weight loss was 42 ± 14 kg at 3 years or later. The number of nutritional deficits per subject was 3.2 ± 2.3 before surgery and did not significantly increase between 1 and 3 years or later after GBP (3.4 ± 2.0 and 3.5 ± 2.3, respectively). However, specific nutritional deficits occurred despite long-term multivitamin supplementation, including vitamins B1, B12, and D and iron. Noncompliant subjects had more deficits than compliant subjects (4.2 ± 1.9 vs 2.9 ± 2.0 deficits per patient, P < 0.01) and the number of deficits correlated with the time from last visit (r = 0.285, P < 0.01). Lifelong medical care is required to maintain a good nutritional status after GBP. Monitoring of nutritional parameters is necessary to add supplementation for deficits that are not prevented by multivitamin preparations.
    • "Several limitations must be recognized, including incomplete follow-up data, in part because our post-RYGB protocol for laboratory monitoring may be individualized and because some patients were lost to follow-up at each postoperative time point. Patient attrition to post-bariatric surgery follow-up is common and efforts at minimizing attrition are important since RYGB patients who do not regularly attend follow-up appointments are more likely to suffer nutritional deficiencies [12] . The true rates of deficiencies in the entire patient population may be higher than what we report. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Roux-en-Y gastric bypass (RYGB) is associated with nutrient deficiencies, but the optimal supplement regimen remains unclear. We assessed patient-reported adherence to and efficacy of Mayo Clinic's post-RYGB vitamin/mineral supplement protocol and the related incidence of common nutrient deficiencies. Methods: Data were collected on 287 obese patients who underwent RYGB. Patient-reported supplement adherence was assessed via medication/supplement lists generated by medication reconciliation in hospital dismissal summaries and clinic notes at 6, 12, and 18-36 months postsurgery. Deficiencies were assessed via measurements of hemoglobin, ferritin, 25-hydroxyvitamin D, and vitamins A, E, and B12 in the setting of our supplementation protocol. Results: Patient-reported adherence to multivitamin/minerals and subcutaneous vitamin B12 was sustained in >92 % of patients, correlating with low rates of vitamin A, E, and B12 deficiencies (4.9, 0, and 3.7 %, respectively). Rates of calcium supplementation decreased (94.1 to 78.7 %) while rates of vitamin D and iron use increased over time (39.7 to 65.8 and 6.3 to 23.1 %, respectively). At 18-36 months, vitamin D deficiency persisted in 16.2 % of patients, iron deficiency in 6.7 % of women and 17.2 % of men, and anemia in 12.2 % of women and 34.3 % of men. Conclusion: Compared to previous reports, we found a lower prevalence of micronutrient deficiencies and excellent patient-reported adherence to a standardized multivitamin/mineral and vitamin B12 regimen. Continued prevalence of vitamin D deficiency prompts consideration of standardized vitamin D supplementation after RYGB. Anemia and iron deficiency were observed at lower rates than previously reported, but were more common in men compared to women.
    Full-text · Article · Apr 2016
    • "While proponents are correct to argue that LRYGBP does eliminate GERD in most patients and it is a successful weight loss operation, the gastric bypass surgery yields significant long term complications associated with the creation of the Roux limb such as ulcers, strictures, intussusceptions, dysfunctional Roux limb syndrome, internal hernias, slippage of the gastric pouch, and dumping syndrome. The SIPS with LF is not subject to these side effects (Iannelli et al. 2006; Ledoux et al. 2014; Gasteyger et al. 2008; Zellmer et al. 2014 ). Because of these side effects, Gastric Bypass may not be an ideal operation for all morbidly obese GERD patients especially for patients who require long term NSAID therapy which is associated with bleeding ulcers postoperatively. "
    [Show abstract] [Hide abstract] ABSTRACT: The increase in the prevalence of obesity and gastroesophageal reflux disease (GERD) has paralleled one another. Laparoscopic fundoplication (LF) (Nissen or Toupet) is a minimally invasive form of anti-reflux surgery. The duodenal switch is a highly effective weight loss surgery with a proven record of long term weight loss success. However, fundoplication alone does not give satisfactory results when used for GERD in morbidly obese patients. Here we present a novel approach combining stomach intestinal pylorus sparing surgery (SIPS) with LF for morbidly obese patients with GERD. The data from patients who underwent the SIPS procedure along with LF in past year was retrospectively analyzed. The variables collected were age, sex, height, weight, intra-operative and post-operative complications, length of stay, operative time, and estimated blood loss. All revisions were excluded. Descriptive statistics such as mean and standard deviation were used to analyze the data. The total sample size of the study was 5 patients, with a mean age of 59.6 ± 16.4 years, a mean weight of 292.1 ± 73.6 lbs., and a mean body mass index (BMI) of 43.4 ± 6.3. Weight loss patterns were the same as those without LF. All the 5 patients had resolution or improvement in their GERD symptoms within 6 months. SIPS with LF provides substantial and sustained weight loss and GERD resolution. Long term follow ups and further study on this novel surgical technique is recommended.
    Full-text · Article · Dec 2015
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Roux-en-Y gastric bypass (RYGB) is considered the gold standard for the treatment of morbid obesity. There is no consensus over ideal limb length when the bypass is created and published studies do not take into account the influence of the common limb (CL) on weight loss. The objective was to study the influence of the common limb after RYGB. The setting was the Virgen de la Arrixaca University Clinical Hospital in Murcia, Spain. Material and methods: This prospective study includes 151 patients undergoing laparoscopic RYGB surgery for morbid obesity. The patients were divided into 2 groups according to their body mass index. The small intestine (SI) was measured using micro forceps so that the percentage of common limb (%CL) could then be compared against the total SI in each patient. The percentage of excess weight loss (%EWL) in relation to the %CL was calculated at 3, 12, and 24 months. A series of tests was conducted simultaneously to analyze nutritional deficiencies and their relation to the %CL. Results: The total jejunoileal segment and the %CL in the groups of both obese and super-obese patients had no influence on the %EWL in either group for any of the periods studied. The patients with a %CL<50% had greater nutritional deficiencies in the follow-up period and required supplements and more frequent laboratory tests. Conclusions: The %CL has no effect on weight loss in RYGB patients. A lower %CL is related to greater nutritional deficiencies.
    Article · Jul 2014
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