Bariatric Times - Supplement A - Covidien - (Page 16)

THE 2007 INTERNATIONAL CONSENSUS SUMMIT ON SLEEVE GASTRECTOMY symptoms, including ataxia, nystagmus, and confusion. There are several case reports of this syndrome in patients following VBG7 and AGB.8 Wernicke’s is the only published nutritional deficiency after sleeve gastrectomy, occurring in a single patient who developed vomiting postoperatively.9 Fat-soluble vitamin levels are clearly also important to follow after malabsorptive operations, but deficiencies are rare after purely restrictive procedures. Finally, calcium and vitamin D levels are extremely important to monitor in all bariatric patients, particularly because of the high prevalence of deficiency preoperatively in these patients (up similar to that of gastric bypass patients. Vitamin supplementation is initiated immediately postoperatively with multivitamins and calcium. Vitamin D is taken if they are deficient preoperatively, and all patients take protein shake supplements. As patients are able to tolerate more dense proteins, the shake supplements are decreased. We do not routinely supplement iron unless patients are deficient preoperatively, as we have found low levels of iron deficiency after sleeve gastrectomy (and in fact equal numbers of patients with high levels of iron and ferritin).12 3. 4. 5. 6. Gasteyger C, Suter M, Calmes JM, et al. Changes in body composition, metabolic profile and nutritional status 24 months after gastric banding. Obes Surg 2006;16(3):243–50. Cooper PL, Brearley LK, Jamieson AC, Ball MJ. Nutritional consequences of modified vertical gastroplasty in obese subjects. Int J Obes Relat Metab Disord 1999;23(4):382–8. Ledoux S, Msika S, Moussa F, et al. Comparison of nutritional consequences of conventional therapy of obesity, adjustable gastric banding, and gastric bypass. Obes Surg 2006;16(8):1041–9. Johnston D, Dachtler J, Sue-Ling HM, et al. The Magenstrasse and Mill operation for morbid obesity. Obes Surg 2003;13(1):10–6. Given the lack of malabsorption, it is reasonable to expect that any deficiency that is encountered may be corrected with judicious supplementation. 7. to 60% vitamin D depletion and 48% elevated PTH levels).10 One group presented their data of 70 patients who underwent sleeve gastrectomy and found a 42-percent incidence of preoperative secondary hyperparathyroidism, which decreased to 28 percent at two years, suggesting that with proper vitamin D supplementation, deficiencies in this axis may be correctable after sleeve gastrectomy.11 After surgery, our patients follow the dietary principles of any restrictive operation—that is, emphasizing consumption of proteins first to promote satiety followed by fruits and vegetables, whole grains, and, finally, fluids. We progress patients from a liquid diet on the first postoperative day up to a pureed diet on the second day. On discharge, they remain on a soft diet (blenderized meats, cottage cheese, apple sauce, oatmeal) for approximately four weeks. Solid foods are then gradually introduced over the following months under the guidance of dedicated nutrition staff, 16 Bariatric Times [ J U N E 2008, SUMMARY To date there is little specific data regarding the nutritional aspects of sleeve gastrectomy. In that it closely resembles the purely restrictive operations, we can expect true deficiencies to be relatively uncommon. Given the lack of malabsorption, it is reasonable to expect that any deficiency that is encountered may be corrected with judicious supplementation. The high preoperative prevalence of calcium and vitamin D deficiency underscores the need for lifelong nutritional monitoring in these patients despite the apparent safety of sleeve gastrectomy. 8. 9. 10. REFERENCES 1. Dolan K, Hatzifotis M, Newbury L, et al. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann Surg 2004;240(1):51–6. Andersen T, Larsen U. Dietary outcome in obese patients treated with a gastroplasty program. Am J Clin Nutr 1989;50(6):1328–40. 11. 2. 12. Seehra H, MacDermott N, Lascelles RG, Taylor TV. Wernicke’s encephalopathy after vertical banded gastroplasty for morbid obesity. BMJ 1996;312(7028):434. Solá E, Morillas C, Garzón S,et al. Rapid onset of Wernicke’s encephalopathy following gastric restrictive surgery. Obes Surg 2003;13(4):661–2. Makarewicz W, Kaska L, Kobiela J, et al. Wernicke’s syndrome after sleeve gastrectomy. Obes Surg 2007;17(5):704–6. Erratum in: Obes Surg 2007;17(7):996. Carlin AM, Rao DS, Meslemani AM, et al. Prevalence of vitamin D depletion among morbidly obese patients seeking gastric bypass surgery. Surg Obes Relat Dis 2006;2(2):98–103; discussion 104. Epub 2006 Feb 28. Lee C, Crookes PF. Calcium homeostasis after bariatric surgery: A comparison of the sleeve gastrectomy, Roux-en-Y gastric bypass, and duodenal switch. Presented at the Annual Meeting of the ASMBS 2007; San Diego, California. Goldenberg L. Nutrition post-sleeve gastrectomy. Presented at the Annual Meeting of the ASMBS 2006; San Francisco, California. SUPPLEMENT A]

Table of Contents Feed for the Digital Edition of Bariatric Times - Supplement A - Covidien

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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