Bariatric Times - Supplement A - Covidien - (Page 15)

THE 2007 INTERNATIONAL CONSENSUS SUMMIT ON SLEEVE GASTRECTOMY Laparoscopic Sleeve Gastrectomy: Nutritional Concerns and Postoperative Dietary Care by GREG DAKIN, MD AUTHOR AFFILIATIONS: Dr. Dakin is from Weill-Cornell Medical College, New York, New York. ADDRESS CORRESPONDENCE TO: Greg Dakin, MD, 525 East 68th Street, Box 294, New York, NY 10065; Phone: (212) 746-5294; Fax: (212) 746-5236; E-mail: grd9006@med.cornell.edu KEY POINTS • Sleeve gastrectomy is likely safe from a nutritional standpoint. • Specific data regarding nutritional defects after sleeve gastrectomy is relatively lacking at this point, and there are no published guidelines regarding nutritional monitoring and supplementation after this operation. • Despite its apparent safety, care follow-up is still recommended given the high preoperative prevalence of some nutritional abnormalities. utritional deficiencies are very common after bariatric surgery, either because of decreased dietary intake, malabsorption, or altered dietary habits. These deficiencies can develop any number of years after the operation takes place, making lifelong nutritional monitoring a must. To date, there is little data regarding nutritional defects after sleeve gastrectomy, and there are no published guidelines regarding nutritional monitoring and supplementation after this operation. This article reviews the common nutritional deficiencies to be considered in patients undergoing sleeve gastrectomy and outlines our basic protocol for postoperative dietary care. N DISCUSSION As there are very few studies regarding nutritional deficiency after sleeve gastrectomy, we must draw inference from studies on comparable operations, including vertical banded gastroplasty (VBG), adjustable gastric banding (AGB), and Magenstrasse and Mill (MM) procedure. Though there may be multiple mechanisms involved with sleeve gastrectomy, it is mainly comparable to these primarily restrictive procedures when considering nutritional deficiencies. Protein malnutrition is certainly [JUNE common after malabsorptive procedures, seen in some series up to 18 percent of patients at 28 months.1 While many older studies demonstrate altered dietary protein intake after restrictive procedures, hypoproteinemia is not common.2 AGB patients have been shown to have normal protein levels at 24 months.3 Iron deficiency and anemia are common after gastric bypass and have been reported after VBG as well. Up to 46 percent anemia and 32 percent iron deficiency have been reported at four years follow-up.4 Iron deficiency was not seen in one series of AGB patients.3 B12 and folate deficiency are commonly followed after weight loss surgery. Older VBG data show little deficiency after short follow-up.4 Newer data regarding AGB are somewhat conflicting, with one study showing no deficiencies,5 while another reports 44 percent of patients with low folate and 11 percent of patient with folate deficiency at 24 months.3 None of 100 MM patients had B12 or folate deficiency at five years.6 Thiamine is an important nutrient to follow after weight loss surgery because its acute deficiency can lead to Wernicke’s encephalopathy, which comprises a constellation of SUPPLEMENT A] 2008, Bariatric Times 15

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Bariatric Times - Supplement A - Covidien Contents Laparoscopic Sleeve Gastrectomy: From Magenstrasse And Mill To Sleeve Sleeve Gastrectomy Provides Resoultion of Type-2 Diabetes Without Duodenal Exclusion The Relationship Bewtween The Resected Remnant And Weight Loss Laparoscopic Sleeve Gastrectomy: Results After Two And Five Years Laparoscopic Sleeve Gastrectomy As An Initial Weight Loss Procedure For High-Risk Patients With Morbid Obesity Three-Year Results Of Laparoscopic Sleeve Gastrectomy In The Treatment Of Morbid Obesity In Korea Laparoscopic Sleeve Gastrectomy: Nutritional Concerns And PostOperative Dietary Care Laparoscopic Sleeve Gastrectomy: Prevention And Treatment Of Bleeding Prevention And Treatment Of Gerd/Hiatal Hernia And Stenosis Associated With Sleeve Gastrectomy Laparoscopic Revisions Of Sleeve Gastrectomy Survey Results

Bariatric Times - Supplement A - Covidien

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