Managing medical and surgical disorders after divided Roux-en-Y gastric bypass surgery

Abstract

The National Longitudinal Study of Adolescent Health and the National Health and Nutrition Examination Survey reported that over 40% of the US population is overweight. The average weight loss attained by medical management programs is neither sufficient nor durable enough to treat medically complicated obesity. An estimated 220,000 bariatric procedures are performed yearly in the USA and Canada. The divided Roux-en-Y gastric bypass (RYGB) is performed most commonly in these countries and is considered the gold standard bariatric surgical procedure. The complexity of RYGB means that serious and potentially preventable perioperative complications can occur. RYGB alters the normal anatomy and physiology of the upper gut, which has predictable adverse effects and potential complications. Patients seek advice and care for symptoms that develop or persist after RYGB; although some symptoms are expected and predictable, others are complications that may or may not require active medical or surgical intervention. Physicians should be able to predict and manage most postoperative medical and nutritional disorders related to RYGB and should be prepared to assess patients for potential referral for surgical intervention or revision.

Changes in Bone Metabolism in Morbidly Obese Patients After Bariatric Surgery: A Meta-Analysis

“…This raises concerns regarding current recommendations for calcium and vitamin D supplementation. Many medical societies recommend taking ≥1200 mg [39], and the Endocrine Society suggests 1200-2000 mg elemental calcium daily and 1000 IU vitamin D3 (cholecalciferol) daily for patients following weight loss surgery [40]. However, this supplementation may be insufficient in individuals who have undergone malabsorptive procedures.…”

Alcohol: Its Role in Nutrition and Health

“…In alcoholic patients, several mechanisms for the development of malnutrition usually occur simultaneously (Table 55.1 ) (Seitz and Suter, 1994 ). After gastric bypass surgery bariatric patients with a higher alcohol intake might elicit a higher risk of alcohol -induced nutritional disorders as well as higher alcohol toxicity due to an altered alcohol absorption kinetic, nutrient malabsorption as well as inadequate nutrient intake (Bal et al , 2010 ;Maluenda et al , 2010 ).…”

Encefalopatía de Wernicke y polineuropatía asociada a déficit de complejo B después de una cirugía bariátrica

“…Como complicación de la cirugía bariátrica en las revisiones sistemáticas recientes, se estimó una incidencia del 0,2 %, aunque se sabe que hasta el 49 % de los pacientes con cirugía bariátrica tienen déficit de tiamina; esto lleva a un preocupante subdiagnóstico (2,8,15,16).…”

“…La progresión del déficit neurológico puede ser tan rápida como de pocos días hasta alcanzar el coma, siendo frecuente el empeoramiento con la administración de glucosa sin tiamina (1)(2)(3)8,14,15,19,29). Esta administración de glucosa parece ser un factor clave dentro de la historia de nuestra paciente y su rápida progresión.…”

“…Aunque está descrito el suplemento antes y después de la cirugía, como medida de prevención de la encefalopatía de Wernicke-polineuropatía, existen reportes de caso y cohortes que informan que el suplemento estándar con multivitamínicos o por protocolo puede no ser efectivo, y que se requiere de suplemento específico antes y después de la cirugía para cada déficit encontrado (2,5,19,27,35).…”