Copper and Zinc Serum Levels after Derivative Bariatric Surgery: Differences Between Roux-en-Y Gastric Bypass and Biliopancreatic Diversion

Abstract

Hypocupremia, and especially hypozincaemia, are frequent findings in BPD patients, but rarely found in patients who underwent RYGB, particularly short RYGB. Our data also suggest that a long-standing and severe hypocupremia is required to develop neurological and haematological disorders after bariatric surgery.

Assessment of Serum Copper State after Gastrectomy with Roux-en-Y Reconstruction for Gastric Cancer

“…The incidence of hypocupremia in the RY group seemed low- er than reported previously for obese patients after RYGB (3.8-9.6%) and BPD (10.1-23.6%) [8,18] . Patients who undergo those operations often suffer several symptoms caused by copper deficiency, such as anemia, neutropenia, and neuromuscular disorder [8,18] . In this study, none of the 5 patients with hypocupremia experienced any symptoms.…”

“…The distal jejunum is brought up and gastrojejunostomy or esophagojejunostomy is performed. Conversely, in RYGB and BPD, the lengths of the Roux (alimentary) limb and proximal segment (biliopancreatic limb) are adjusted according to preoperative clinical factors such as BMI, and the jejunum is usually transected 30-80 cm and 150-200 cm distal to the ligament of Treitz, respectively [8,[19][20][21] . As a result, our procedure can preserve a longer alimentary jejunum and thus contribute to copper absorption and the maintenance of SCLs.…”

“…Copper is absorbed mainly from the duodenum and proximal jejunum, and partly from the stomach [6,7] . Some recent reports have noted that copper deficiency can occur in obese patients who have undergone bariatric surgery, such as Roux-en-Y (RY) gastric bypass (RYGB) or biliopancreatic diversion (BPD), or in patients who receive enteral nutrition through a jejunostomy [8,9] . Theoretically, patients who undergo gastrectomy for gastric cancer followed by RY reconstruction have the possibility of experiencing copper deficiency when food bypasses the duodenum and proximal jejunum, as the main regions engaged in copper absorption.…”

A.S.P.E.N. Clinical Guidelines

“…These have compared serum levels in cohorts of patients treated with different procedures and have included RYGB, sleeve gastrectomy (SG), BPD ± DS, and adjustable gastric band procedures. The duration of follow-up was generally short, with 16 studies covering 1-3 years, 69-82 3 studies 4-5 years [83][84][85] and 1 study 7 years. 86 The study of longest duration documented no deficiency states in patients with restrictive procedures but no malabsorptive component; however, the others have documented an increased risk of deficiency of iron, copper, zinc, selenium, thiamine, folate, and Vitamins B 12 and D as compared with preoperative populations.…”

Zinc and Copper Serum Levels of Morbidly Obese Patients Before and After Biliopancreatic Diversion: 4 Years of Follow-up

“…6 However, few studies have been conducted specifically to investigate these deficiencies in patients who underwent bariatric surgery. Comminetti et al 7 evaluated zinc deficiency in patients after Roux-en-Y gastric bypass, Madan et al 8 studied zinc deficiency in patients after laparoscopic bypass, and Balsa et al 9 evaluated zinc and copper deficiencies after gastric bypass and BPD.…”