Abstract:Obesity, defined as a body mass index over 30 kg/m(2) for adults, poses a major healthcare challenge with important economic, personal and social consequences. Although public health measures, lifestyle change and pharmacological therapies have an important role in the management of obesity, patients with established morbid obesity (body mass index over 40 kg/m(2)) may also require bariatric surgery. Bariatric or metabolic surgery is associated with effective and enduring weight loss but is also known to impro… Show more
“…A recent study by Bensky et al which compared sublingual with intramuscular method of vitamin B 12 supplementation in deficient patients concluded that sublingual application is sufficient or even superior to the latter [27]. Other routes of vitamin [28]. As Stein et al reported in the review article, postsurgical vitamin B 12 deficiency leading to anaemia occurs much more often in RYGB cohort than in LSG cohort.…”
Introduction Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the two most frequently performed bariatric operations. These two types of metabolic surgery alter the anatomy and function of digestive tract producing significant weight loss in morbidly obese patients but may lead to malnutrition. Aim Analysis of incidence and severity of malnutrition after bariatric surgery in patients submitted to RYGB or LSG during 12 months of follow-up. Material and Methods Retrospective study of 98 patients after RYGB (n = 47) or LSG (n = 51) assessed for nutritional deficiencies during 12 months after surgery was conducted. The differences in body mass index (BMI) and blood tests including erythrocytes, haemoglobin, total protein, albumin, iron, ferritin, transferrin, vitamin B12, folic acid, calcium and phosphorus concentrations were compared between groups before the operations and at 1 and 12 months. Results Nutritional deficiencies were common before surgery with prevalence up to 19.6% for albumin in the LSG group. Median preoperative BMI levels and albumin concentrations were higher in the RYGB group compared to the LSG group, but there was no difference in percent excess weight loss (%EWL) at 1 and 12 months between LSG and RYGB. One month after LSG erythrocyte count, haemoglobin, iron, ferritin and transferrin levels were significantly higher than in the RYGB group. These differences subsided at 12 months. At 12 months, only the prevalence of vitamin B 12 deficiency was significantly higher in the RYGB group. Conclusion Both RYGB and LSG lead to nutritional deficiencies despite different properties of operations and similar %EWL during follow-up.
“…A recent study by Bensky et al which compared sublingual with intramuscular method of vitamin B 12 supplementation in deficient patients concluded that sublingual application is sufficient or even superior to the latter [27]. Other routes of vitamin [28]. As Stein et al reported in the review article, postsurgical vitamin B 12 deficiency leading to anaemia occurs much more often in RYGB cohort than in LSG cohort.…”
Introduction Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the two most frequently performed bariatric operations. These two types of metabolic surgery alter the anatomy and function of digestive tract producing significant weight loss in morbidly obese patients but may lead to malnutrition. Aim Analysis of incidence and severity of malnutrition after bariatric surgery in patients submitted to RYGB or LSG during 12 months of follow-up. Material and Methods Retrospective study of 98 patients after RYGB (n = 47) or LSG (n = 51) assessed for nutritional deficiencies during 12 months after surgery was conducted. The differences in body mass index (BMI) and blood tests including erythrocytes, haemoglobin, total protein, albumin, iron, ferritin, transferrin, vitamin B12, folic acid, calcium and phosphorus concentrations were compared between groups before the operations and at 1 and 12 months. Results Nutritional deficiencies were common before surgery with prevalence up to 19.6% for albumin in the LSG group. Median preoperative BMI levels and albumin concentrations were higher in the RYGB group compared to the LSG group, but there was no difference in percent excess weight loss (%EWL) at 1 and 12 months between LSG and RYGB. One month after LSG erythrocyte count, haemoglobin, iron, ferritin and transferrin levels were significantly higher than in the RYGB group. These differences subsided at 12 months. At 12 months, only the prevalence of vitamin B 12 deficiency was significantly higher in the RYGB group. Conclusion Both RYGB and LSG lead to nutritional deficiencies despite different properties of operations and similar %EWL during follow-up.
“…Patients should be assessed after surgery for the long‐term continuation of medication for diabetes and hypertension. These medications may require complete cessation or dose modifications in the immediate postoperative period (with regular monitoring of blood pressure (BP) and capillary or venous glucose) to prevent postural hypotension and hypoglycaemia, respectively . All other medications need to be taken with dose modifications if required.…”
Section: Service Description/care Pathwaymentioning
confidence: 99%
“…Patients are advised not to get pregnant within 18 months following bariatric surgery due to potential adverse consequences, both to the mother and the foetus .Those who are of child‐bearing age and sexually active are encouraged to use appropriate non‐oral contraception (implant, intra‐uterine or barrier). The approaches are believed to be the best because of the potential for vomiting or diarrhoea after surgery and impaired absorption of oral contraception in malabsorptive and restrictive procedures .Recommendation: Women are advised not to get pregnant within 18 months following bariatric surgery.…”
Section: Service Description/care Pathwaymentioning
confidence: 99%
“…Patients will need liquid preparation of necessary drugs during the early postoperative period, e.g. thyroxine, immunosuppressants, antipsychotics, anticonvulsants and so on . Some drugs might need to be substituted with alternative drugs or increased doses due to impact on their absorption site depending on the bariatric surgery type, e.g.…”
Section: Service Description/care Pathwaymentioning
confidence: 99%
“…This includes staff working in emergency departments, obstetricians, midwives and dieticians. E‐learning modules on the management of bariatric surgery patients need to be developed and available.Recommendation: Healthcare professionals need to have an awareness of potential complications post bariatric surgery and refer back to the bariatric team in a timely and appropriate manner.Continuing professional development education modules should be developed .Evidence Grade DRecommendation: Healthcare professionals, including obstetricians, midwives, dieticians and emergency department staff, need training in the management of bariatric surgery patients. This could be in the form of e‐learning modules.Evidence: GRADE D…”
Section: Recommendations For Future Development Of Servicementioning
Bariatric surgery can facilitate weight loss and improvement in medical comorbidities. It has a profound impact on nutrition, and patients need access to follow-up and aftercare. NICE CG189 Obesity emphasized the importance of a minimum of 2 years follow-up in the bariatric surgical service and recommended that following discharge from the surgical service, there should be annual monitoring as part of a shared care model of chronic disease management. NHS England Obesity Clinical Reference Group commissioned a multi-professional subgroup, which included patient representatives, to develop bariatric surgery follow-up guidelines. Terms of reference and scope were agreed upon. The group members took responsibility for different sections of the guidelines depending on their areas of expertise and experience. The quality of the evidence was rated and strength graded. Four different shared care models were proposed, taking into account the variation in access to bariatric surgical services and specialist teams across the country. The common features include annual review, ability for a GP to refer back to specialist centre, submission of follow-up data to the national data base to NBSR. Clinical commissioning groups need to ensure that a shared care model is implemented as patient safety and long-term follow-up are important.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
