Skip to main content
SpringerLink
Log in

Nutritional Complications and Emergencies

  • Chapter
  • First Online:
Bariatric Surgery Complications and Emergencies

  • 1422 Accesses

Abstract

Successful management of bariatric patients involves vigilant preoperative and postoperative planning for prevention of complications. Short- and long-term consequences following Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy include a wide range of nutritional deficiencies. Risk factors for nutritional complications may include poor dietary intake, noncompliance with the postoperative regimen, or the type of surgical procedure. Because both the preoperative and postoperative prevalence of vitamin and mineral deficiency in bariatric patients are higher than the in general population, nutritional care demands an appreciation of bariatric physiology and patient behavior.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Brolin RE, Gorman RC, Milgrim LM, Kenler HA. Multivitamin prophylaxis in prevention of post-gastric bypass vitamin and mineral deficiencies. Int J Obes. 1991;15(10):661–7.

    CAS  PubMed  Google Scholar 

  2. Stefater MA, Wilson-Pérez HE, Chambers AP, Sandoval DA, Seeley RJ. All bariatric surgeries are not created equal: insights from mechanistic comparisons. Endocr Rev. 2012;33(4):595–622.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Gasteyger C, Suter M, Calmes JM, Gaillard RC, Giusti V. Changes in body composition, metabolic profile and nutritional status 24 months after gastric banding. Obes Surg. 2006;16(3):243–50.

    Article  CAS  PubMed  Google Scholar 

  4. van Rutte PW, Aarts EO, Smulders JF, Nienhuijs SW. Nutrient deficiencies before and after sleeve gastrectomy. Obes Surg. 2014;24(10):1639–46.

    Article  PubMed  Google Scholar 

  5. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  CAS  PubMed  Google Scholar 

  6. Carrodeguas L, Kaidar-Person O, Szomstein S, Antozzi P, Rosenthal R. Preoperative thiamine deficiency in obese population undergoing laparoscopic bariatric surgery. Surg Obes Relat Dis. 2005;1(6):517–22.

    Article  PubMed  Google Scholar 

  7. Lakhani SV, Shah HN, Alexander K, Finelli FC, Kirkpatrick JR, Koch TR. Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients. Nutr Res. 2008;28(5):293–8.

    Article  CAS  PubMed  Google Scholar 

  8. Rudnicki SA. Prevention and treatment of peripheral neuropathy after bariatric surgery. Curr Treat Options Neurol. 2010;12(1):29–36.

    Article  PubMed  Google Scholar 

  9. Sechi G, Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007;6(5):442–55.

    Article  CAS  PubMed  Google Scholar 

  10. Flancbaum L, Belsley S, Drake V, Colarusso T, Tayler E. Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg. 2006;10(7):1033–7.

    Article  PubMed  Google Scholar 

  11. Turkki PR, Ingerman L, Schroeder LA, Chung RS, Chen M, Russo-Mcgraw MA, et al. Thiamin and vitamin B6 intakes and erythrocyte transketolase and aminotransferase activities in morbidly obese females before and after gastroplasty. J Am Coll Nutr. 1992;11(3):272–82.

    Article  CAS  PubMed  Google Scholar 

  12. Mallory GN, Macgregor AM. Folate status following gastric bypass surgery (the great folate mystery). Obes Surg. 1991;1(1):69–72.

    Article  PubMed  Google Scholar 

  13. Madan AK, Orth WS, Tichansky DS, Ternovits CA. Vitamin and trace mineral levels after laparoscopic gastric bypass. Obes Surg. 2006;16(5):603–6.

    Article  PubMed  Google Scholar 

  14. Carmel R, Green R, Rosenblatt DS, Watkins D. Update on cobalamin, folate, and homocysteine. Hematol Am Soc Hematol Educ Program. 2003;62–81.

    Google Scholar 

  15. Shane B, Stokstad EL. Vitamin B12-folate interrelationships. Annu Rev Nutr. 1985;5:115–41.

    Article  CAS  PubMed  Google Scholar 

  16. Skroubis G, Sakellaropoulos G, Pouggouras K, Mead N, Nikiforidis G, Kalfarentzos F. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass. Obes Surg. 2002;12(4):551–8.

    Article  PubMed  Google Scholar 

  17. Aasheim ET, Johnson LK, Hofsø D, Bøhmer T, Hjelmesæth J. Vitamin status after gastric bypass and lifestyle intervention: a comparative prospective study. Surg Obes Relat Dis. 2012;8(2):169–75.

    Article  PubMed  Google Scholar 

  18. Pinhas-Hamiel O, Doron-Panush N, Reichman B, Nitzan-Kaluski D, Shalitin S, Geva-Lerner L. Obese children and adolescents: a risk group for low vitamin B12 concentration. Arch Pediatr Adolesc Med. 2006;160(9):933–6.

    Article  PubMed  Google Scholar 

  19. Sumner AE, Chin MM, Abrahm JL, Berry GT, Gracely EJ, Allen RH, et al. Elevated methylmalonic acid and total homocysteine levels show high prevalence of vitamin B12 deficiency after gastric surgery. Ann Intern Med. 1996;124(5):469–76.

    Article  CAS  PubMed  Google Scholar 

  20. Herrmann W, Obeid R. Causes and early diagnosis of vitamin B12 deficiency. Dtsch Arztebl Int. 2008;105(40):680–5.

    PubMed  PubMed Central  Google Scholar 

  21. Obinwanne KM, Fredrickson KA, Mathiason MA, Kallies KJ, Farnen JP, Kothari SN. Incidence, treatment, and outcomes of iron deficiency after laparoscopic Roux-en-Y gastric bypass: a 10-year analysis. J Am Coll Surg. 2014;218(2):246–52.

    Article  PubMed  Google Scholar 

  22. Brolin RE, Gorman JH, Gorman RC, Petschenik AJ, Bradley LJ, Kenler HA, et al. Are vitamin B12 and folate deficiency clinically important after roux-en-Y gastric bypass? J Gastrointest Surg. 1998;2(5):436–42.

    Article  CAS  PubMed  Google Scholar 

  23. Evstatiev R, Marteau P, Iqbal T, Khalif IL, Stein J, Bokemeyer B, et al. FERGIcor, a randomized controlled trial on ferric carboxymaltose for iron deficiency anemia in inflammatory bowel disease. Gastroenterology. 2011;141(3):846–53.

    Article  CAS  PubMed  Google Scholar 

  24. Brolin RE, Gorman JH, Gorman RC, Petschenik AJ, Bradley LB, Kenler HA, et al. Prophylactic iron supplementation after Roux-en-Y gastric bypass: a prospective, double-blind, randomized study. Arch Surg. 1998;133(7):740–4.

    Article  CAS  PubMed  Google Scholar 

  25. Diniz Mde F, Diniz MT, Sanches SR, Salgado PP, Valadão MM, Araújo FC, et al. Elevated serum parathormone after Roux-en-Y gastric bypass. Obes Surg. 2004;14(9):1222–6.

    Article  PubMed  Google Scholar 

  26. Carlin AM, Rao DS, Yager KM, Genaw JA, Parikh NJ, Szymanski W. Effect of gastric bypass surgery on vitamin D nutritional status. Surg Obes Relat Dis. 2006;2(6):638–42.

    Article  PubMed  Google Scholar 

  27. Goldner WS, Stoner JA, Lyden E, Thompson J, Taylor K, Larson L, et al. Finding the optimal dose of vitamin D following Roux-en-Y gastric bypass: a prospective, randomized pilot clinical trial. Obes Surg. 2009;19(2):173–9.

    Article  PubMed  Google Scholar 

  28. Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2010;95(11):4823–43.

    Article  CAS  PubMed  Google Scholar 

  29. Hewitt S, Søvik TT, Aasheim ET, Kristinsson J, Jahnsen J, Birketvedt GS, et al. Secondary hyperparathyroidism, vitamin D sufficiency, and serum calcium 5 years after gastric bypass and duodenal switch. Obes Surg. 2013;23(3):384–90.

    Article  PubMed  Google Scholar 

  30. Brethauer SA, Chand B, Schauer PR. Risks and benefits of bariatric surgery: current evidence. Cleve Clin J Med. 2006;73(11):993–1007.

    Article  PubMed  Google Scholar 

  31. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21 Suppl 1:S1–27.

    Article  CAS  Google Scholar 

  32. Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring). 2009;17 Suppl 1:S1–70.

    Google Scholar 

  33. Neuhouser ML, Rock CL, Eldridge AL, Kristal AR, Patterson RE, Cooper DA, et al. Serum concentrations of retinol, alpha-tocopherol and the carotenoids are influenced by diet, race and obesity in a sample of healthy adolescents. J Nutr. 2001;131(8):2184–91.

    CAS  PubMed  Google Scholar 

  34. Clements RH, Katasani VG, Palepu R, Leeth RR, Leath TD, Roy BP, et al. Incidence of vitamin deficiency after laparoscopic Roux-en-Y gastric bypass in a university hospital setting. Am Surg. 2006;72(12):1196–202. discussion 1203–4.

    PubMed  Google Scholar 

  35. Zalesin KC, Miller WM, Franklin B, Mudugal D, Rao Buragadda A, Boura J, et al. Vitamin a deficiency after gastric bypass surgery: an underreported postoperative complication. J Obes. 2011;2011. pii:760695.

    Google Scholar 

  36. Pereira S, Saboya C, Ramalho A. Impact of different protocols of nutritional supplements on the status of vitamin A in class III obese patients after Roux-en-Y gastric bypass. Obes Surg. 2013;23(8):1244–51.

    Article  PubMed  Google Scholar 

  37. Ueda N, Suzuki Y, Rino Y, Takahashi T, Imada T, Takanashi Y, et al. Correlation between neurological dysfunction with vitamin E deficiency and gastrectomy. J Neurol Sci. 2009;287(1–2):216–20.

    Article  CAS  PubMed  Google Scholar 

  38. Koch TR, Finelli FC. Postoperative metabolic and nutritional complications of bariatric surgery. Gastroenterol Clin North Am. 2010;39(1):109–24.

    Article  PubMed  Google Scholar 

  39. Bersani I, De Carolis MP, Salvi S, Zecca E, Romagnoli C, De Carolis S. Maternal-neonatal vitamin K deficiency secondary to maternal biliopancreatic diversion. Blood Coagul Fibrinolysis. 2011;22(4):334–6.

    Article  PubMed  Google Scholar 

  40. Allied Health Sciences Section Ad Hoc Nutrition Committee, Aills L, Blankenship J, Buffington C, Furtado M, Parrott J. ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis. 2008;4(5 Suppl):S73–108.

    Google Scholar 

  41. Gehrer S, Kern B, Peters T, Christoffel-Courtin C, Peterli R. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)–a prospective study. Obes Surg. 2010;20(4):447–53.

    Article  PubMed  Google Scholar 

  42. Ernst B, Thurnheer M, Schmid SM, Schultes B. Evidence for the necessity to systematically assess micronutrient status prior to bariatric surgery. Obes Surg. 2009;19(1):66–73.

    Article  PubMed  Google Scholar 

  43. Olivares M, Pizarro F, Ruz M, de Romaña DL. Acute inhibition of iron bioavailability by zinc: studies in humans. Biometals. 2012;25(4):657–64.

    Article  CAS  PubMed  Google Scholar 

  44. Balsa JA, Botella-Carretero JI, Gómez-Martín JM, Peromingo R, Arrieta F, Santiuste C, et al. Copper and zinc serum levels after derivative bariatric surgery: differences between Roux-en-Y gastric bypass and biliopancreatic diversion. Obes Surg. 2011;21(6):744–50.

    Article  PubMed  Google Scholar 

  45. Lazarchick J. Update on anemia and neutropenia in copper deficiency. Curr Opin Hematol. 2012;19(1):58–60.

    Article  CAS  PubMed  Google Scholar 

  46. Kimmons JE, Blanck HM, Tohill BC, Zhang J, Khan LK. Associations between body mass index and the prevalence of low micronutrient levels among US adults. MedGenMed. 2006;8(4):59.

    PubMed  PubMed Central  Google Scholar 

  47. Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26(11–12):1031–7.

    Article  CAS  PubMed  Google Scholar 

  48. Boldery R, Fielding G, Rafter T, Pascoe AL, Scalia GM. Nutritional deficiency of selenium secondary to weight loss (bariatric) surgery associated with life-threatening cardiomyopathy. Heart Lung Circ. 2007;16(2):123–6.

    Article  PubMed  Google Scholar 

  49. Luk CP, Parsons R, Lee YP, Hughes JD. Proton pump inhibitor-associated hypomagnesemia: what do FDA data tell us? Ann Pharmacother. 2013;47(6):773–80.

    Article  PubMed  Google Scholar 

  50. Dalcanale L, Oliveira CP, Faintuch J, Nogueira MA, Rondó P, Lima VM, et al. Long-term nutritional outcome after gastric bypass. Obes Surg. 2010;20(2):181–7.

    Article  PubMed  Google Scholar 

  51. Crowley LV, Seay J, Mullin G. Late effects of gastric bypass for obesity. Am J Gastroenterol. 1984;79(11):850–60.

    CAS  PubMed  Google Scholar 

  52. Song A, Fernstrom MH. Nutritional and psychological considerations after bariatric surgery. Aesthet Surg J. 2008;28(2):195–9.

    Article  CAS  PubMed  Google Scholar 

  53. Chaston TB, Dixon JB, O’Brien PE. Changes in fat-free mass during significant weight loss: a systematic review. Int J Obes (Lond). 2007;31(5):743–50.

    CAS  Google Scholar 

  54. Moizé V, Andreu A, Rodríguez L, Flores L, Ibarzabal A, Lacy A, et al. Protein intake and lean tissue mass retention following bariatric surgery. Clin Nutr. 2013;32(4):550–5.

    Article  PubMed  Google Scholar 

  55. Levinson R, Silverman JB, Catella JG, Rybak I, Jolin H, Isom K. Pharmacotherapy prevention and management of nutritional deficiencies post Roux-en-Y gastric bypass. Obes Surg. 2013;23(7):992–1000.

    Article  PubMed  Google Scholar 

  56. Andreu A, Moizé V, Rodríguez L, Flores L, Vidal J. Protein intake, body composition, and protein status following bariatric surgery. Obes Surg. 2010;20(11):1509–15.

    Article  PubMed  Google Scholar 

  57. Snyder-Marlow G, Taylor D, Lenhard MJ. Nutrition care for patients undergoing laparoscopic sleeve gastrectomy for weight loss. J Am Diet Assoc. 2010;110(4):600–7.

    Article  PubMed  Google Scholar 

  58. Layman DK. Protein quantity and quality at levels above the RDA improves adult weight loss. J Am Coll Nutr. 2004;23(6 Suppl):631S–6.

    Article  CAS  PubMed  Google Scholar 

  59. Dao T, Kuhn J, Ehmer D, Fisher T, McCarty T. Pregnancy outcomes after gastric-bypass surgery. Am J Surg. 2006;192(6):762–6.

    Article  PubMed  Google Scholar 

  60. Dixon JB, Dixon ME, O’Brien PE. Birth outcomes in obese women after laparoscopic adjustable gastric banding. Obstet Gynecol. 2005;106(5 Pt 1):965–72.

    Article  PubMed  Google Scholar 

  61. Weiss HG, Nehoda H, Labeck B, Hourmont K, Marth C, Aigner F. Pregnancies after adjustable gastric banding. Obes Surg. 2001;11(3):303–6.

    Article  CAS  PubMed  Google Scholar 

  62. Patel JA, Patel NA, Thomas RL, Nelms JK, Colella JJ. Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4(1):39–45.

    Article  PubMed  Google Scholar 

  63. Eerdekens A, Debeer A, Van Hoey G, De Borger C, Sachar V, Guelinckx I, et al. Maternal bariatric surgery: adverse outcomes in neonates. Eur J Pediatr. 2010;169(2):191–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General & Vascular Surgery, Bariatric and Metabolic Institute and Section of Minimally Invasive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA

    Samuel Szomstein MD, FACS, FASMBS & David M. Nguyen MD

Authors
  1. Samuel Szomstein MD, FACS, FASMBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David M. Nguyen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samuel Szomstein MD, FACS, FASMBS .

Editor information

Editors and Affiliations

  1. Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA

    Daniel M. Herron

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Szomstein, S., Nguyen, D.M. (2016). Nutritional Complications and Emergencies. In: Herron, D. (eds) Bariatric Surgery Complications and Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-27114-9_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-27114-9_22

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27112-5

  • Online ISBN: 978-3-319-27114-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation