Skip to main content
SpringerLink
Log in

Long-Term Nutritional/Metabolic Sequelae of Bariatric Surgery

  • Chapter
  • First Online:
The SAGES Manual of Bariatric Surgery

  • 1608 Accesses

Abstract

Although weight loss is an important outcome after bariatric surgery, metabolic-related comorbid diseases commonly improve after these procedures. These desirable effects have led to the birth of “metabolic” surgery. Impressive and long-lasting weight loss is one of the successes of these procedures. However the metabolic effect goes beyond weight loss; bariatric surgery leads to the control and remission of type 2 diabetes (T2D), one of the most impactful medical comorbidities of severe obesity affecting quality and length of life, making bariatric surgery a valid option for the treatment of this disease. Additionally, improving hypertension and lipid profile; reducing the risk for myocardial infarction, stroke, and adverse cardiovascular events; yielding profound improvements in obstructive sleep apnea and quality of life; and greatly decreasing risk for cancer and overall adjusted mortality, bariatric surgery has life-changing benefits. Nevertheless, the profound metabolic impact of bariatric surgery can carry sequelae and alter nutritional parameters too. Practitioners caring for bariatric patients in the long term need to be aware of frequently reported complications, including hypoglycemia, neuropathies, and nutrient deficiencies.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight 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. Shibata HR, MacKenzie JR, Long RC. Metabolic effects of controlled jejunocolic bypass. Arch Surg. 1967;95(3):413–28.

    Article  CAS  PubMed  Google Scholar 

  2. Scott HW Jr, Dean R, Shull HJ, Abram HS, Webb W, Younger RK, Brill AB. Considerations in use of jejunoileal bypass in patients with morbid obesity. Ann Surg. 1973;177(6):723–35.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Courcoulas AP, Christian NJ, Belle SH, Berk PD, Flum DR, Garcia L, Horlick M, Kalarchian MA, King WC, Mitchell JE, Patterson EJ, Pender JR, Pomp A, Pories WJ, Thirlby RC, Yanovski SZ, Wolfe BM. Longitudinal assessment of bariatric surgery (LABS) consortium. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310(22):2416–25.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjöström CD, Sullivan M, Wedel H. Swedish obese subjects study scientific group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  6. Adams TD, Davidson LE, Litwin SE, Kolotkin RL, LaMonte MJ, Pendleton RC, Strong MB, Vinik R, Wanner NA, Hopkins PN, Gress RE, Walker JM, Cloward TV, Nuttall RT, Hammoud A, Greenwood JL, Crosby RD, McKinlay R, Simper SC, Smith SC, Hunt SC. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308(11):1122–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, Barakat HA, deRamon RA, Israel G, Dolezal JM, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Sugerman HJ, Wolfe LG, Sica DA, Clore JN. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg. 2003;237(6):751–6.

    PubMed  PubMed Central  Google Scholar 

  9. Higa K, Ho T, Tercero F, Yunus T, Boone KB. Laparoscopic roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7(4):516–25.

    Article  PubMed  Google Scholar 

  10. Schauer PR, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G, Eid GM, Mattar S, Ramanathan R, Barinas-Mitchel E, Rao RH, Kuller L, Kelley D. Effect of laparoscopic roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84.

    PubMed  PubMed Central  Google Scholar 

  11. Wittgrove AC, Clark GW. Laparoscopic gastric bypass, roux-en-Y- 500 patients: technique and results, with 3-60 month follow-up. Obes Surg. 2000;10(3):233–9.

    Article  CAS  PubMed  Google Scholar 

  12. Aftab H, Risstad H, Søvik TT, Tomm Bernklev PD, Hewitt S, Kristinsson JA, Mala T. Five-year outcome after gastric bypass for morbid obesity in a Norwegian cohort. Surg Obes Relat Dis. 2014;10(1):71–8.

    Article  PubMed  Google Scholar 

  13. Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, Thomas S, Abood B, Nissen SE, Bhatt DL. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, Nanni G, Pomp A, Castagneto M, Ghirlanda G, Rubino F. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.

    Article  CAS  PubMed  Google Scholar 

  15. Dixon JB, O'Brien PE, Playfair J, Chapman L, Schachter LM, Skinner S, Proietto J, Bailey M, Anderson M. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316–23.

    Article  CAS  PubMed  Google Scholar 

  16. Philip RS, Deepak LB, John PK, Kathy W, Ali A, Stacy AB, Sankar DN, Rishi PS, Claire EP, Steven EN, Sangeeta RK. Bariatric surgery versus intensive medical therapy for diabetes – 5-year outcomes. N Engl J Med. 2017;376:641–51.

    Article  Google Scholar 

  17. Mingrone G, Panunzi S, De Gaetano A. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 years follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964–73.

    Article  PubMed  Google Scholar 

  18. Ricci C, Gaeta M, Rausa E, Macchitella Y, Bonavina L. Early impact of bariatric surgery on type II diabetes, hypertension, and hyperlipidemia: a systematic review, meta-analysis and meta-regression on 6,587 patients. Obes Surg. 2014;24(4):522–8.

    Article  PubMed  Google Scholar 

  19. Sjöström L. Review of the key results from the Swedish obese subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34.

    Article  PubMed  Google Scholar 

  20. Moore LL, Visioni AJ, Wilson PW, D'Agostino RB, Finkle WD, Ellison RC. Can sustained weight loss in overweight individuals reduce the risk of diabetes mellitus? Epidemiology. 2000;11(3):269–73.

    Article  CAS  PubMed  Google Scholar 

  21. Diabetes Prevention Program Research Group, Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday JO, Goldberg R, Venditti E, Nathan DM. 10-year follow-up of diabetes incidence and weight loss in the diabetes prevention program outcomes study. Lancet. 2009;374(9702):1677–86.

    Article  PubMed Central  Google Scholar 

  22. Sjöström L, Peltonen M, Jacobson P, Ahlin S, Andersson-Assarsson J, Anveden Å, Bouchard C, Carlsson B, Karason K, Lönroth H, Näslund I, Sjöström E, Taube M, Wedel H, Svensson PA, Sjöholm K, Carlsson LM. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297–304.

    Article  PubMed  Google Scholar 

  23. Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KGMM, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39(6):861–77.

    Article  CAS  PubMed  Google Scholar 

  24. Kassem MAM, Durda MA, Stoicea N, Cavus O, Sahin L, Rogers B. The impact of bariatric surgery on type 2 diabetes mellitus and the management of hypoglycemic events. Front Endocrinol. 2017;8:1–6.

    Article  Google Scholar 

  25. Millstein R, Lawler HM. Hypoglycemia after gastric bypass: an emerging complication. Cleve Clin J Med. 2017;84(4):319–28.

    Article  PubMed  Google Scholar 

  26. Øhrstrøm CC, Worm D, Hansen DL. Postprandial hyperinsulinemic hypoglycemiaafter roux-en-Y gastric bypass: an update. Surg Obes Relat Dis. 2017;13(2):345–51.

    Article  PubMed  Google Scholar 

  27. Kefurt R, Langer FB, Schindler K, Shakeri-Leidenmühler S, Ludvik B, Prager G. Hypoglycemia after Roux-En-Y gastric bypass: detection rates of continuous glucose monitoring (CGM) versus mixed meal test. Surg Obes Relat Dis. 2015;11(3):564–9.

    Article  PubMed  Google Scholar 

  28. Hanaire H, Bertrand M, Guerci B, Anduze Y, Guillaume E, Ritz P. High glycemic variability assessed by continuous glucose monitoring after surgical treatment of obesity by gastric bypass. Diabetes Technol Ther. 2011;13(6):625–30.

    Article  CAS  PubMed  Google Scholar 

  29. Jiménez A, Ceriello A, Casamitjana R, Flores L, Viaplana-Masclans J, Vidal J. Remission of type 2 diabetes after roux-en-Y gastric bypass or sleeve gastrectomy is associated with a distinct glycemic profile. Ann Surg. 2015;261(2):316–22.

    Article  PubMed  Google Scholar 

  30. Ritz P, Vaurs C, Barigou M, Hanaire H. Hypoglycaemia after gastric bypass: mechanisms and treatment. Diabetes Obes Metab. 2016;18(3):217–23.

    Article  CAS  PubMed  Google Scholar 

  31. Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275–87.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kwok CS, Pradhan A, Khan MA, Anderson SG, Keavney BD, Myint PK, Mamas MA, Loke YK. Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis. Int J Cardiol. 2014;173(1):20–8. 1499–509

    Article  PubMed  Google Scholar 

  33. Sjöström L, Peltonen M, Jacobson P, Sjöström CD, Karason K, Wedel H, Ahlin S, Anveden Å, Bengtsson C, Bergmark G, Bouchard C, Carlsson B, Dahlgren S, Karlsson J, Lindroos AK, Lönroth H, Narbro K, Näslund I, Olbers T, Svensson PA, Carlsson LM. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65.

    Article  PubMed  Google Scholar 

  34. Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient – 2016 update: micronutrients. Surg Obes Relat Dis. 2017;13(5):727–41.

    Article  PubMed  Google Scholar 

  35. Marcotte E, Chand B. Management and prevention of surgical and nutritional complications after bariatric surgery. Surg Clin North Am. 2016;96(4):843–56.

    Article  PubMed  Google Scholar 

  36. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S. 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. SOARD. 2013;9:159–91.

    Google Scholar 

  37. Aills L, Blankenship J, Buffington C, Furtado M, Parrott J. ASMBS allied health nutritional guidelines for the surgical weight loss patient. SOARD. 2008;4:S73–S108.

    Google Scholar 

  38. Berger KR, Singhal D. The neurologic complications of bariatric surgery. In: Handbook of Clinical Neurology, (3rd series). Neurologic Aspects of Systemic Disease Part II. Elsevier; 2014; 120.: Chapter 39.

    Google Scholar 

  39. Becker DA, Balcer LJ, Galetta SL. The neurological complications of nutritional deficiency following bariatric surgery. J Obes. 2012;2012:608534. Epub 2012 Jun 13

    Article  PubMed  PubMed Central  Google Scholar 

  40. Nguyen NT, DeMaria EJ, Ikramuddin S, Hutter MM. The SAGES manual: a practical guide to bariatric surgery. New York: Springer; 2008.

    Book  Google Scholar 

  41. Moize V, Geliebter A, Gluck ME, Yahav E, Lorence M, Colarusso T, Drake V, Flancbaum L. Obese patients have inadequate protein intake related to protein intolerance up to 1 year following roux-en-Y gastric bypass. Obes Surg. 2003;13(1):23–8.

    Article  PubMed  Google Scholar 

  42. Rabkin RA, Rabkin JM, Metcalf B, Lazo M, Rossi M, Lehman-Becker LB. Nutritional markers following duodenal switch for morbid obesity. Obes Surg. 2004;14(1):84–90.

    Article  PubMed  Google Scholar 

  43. Totté E, Hendrickx L, van Hee R. Biliopancreatic diversion for treatment of morbid obesity: experience in 180 consecutive cases. Obes Surg. 1999;9(2):161–5.

    Article  PubMed  Google Scholar 

  44. Nicoletti CF, Morandi Junqueira-Franco MV, dos Santos JE, Marchini JS, Salgado W Jr, Nonino CB. Protein and amino acid status before and after bariatric surgery: a 12-month follow-up study. Surg Obes Relat Dis. 2013;9(6):1008–12.

    Article  PubMed  Google Scholar 

  45. de Luis DA, Pacheco D, Izaola O, Terroba MC, Cuellar L, Cabezas G. Micronutrient status in morbidly obese women before bariatric surgery. Surg Obes Relat Dis. 2013;9(2):323–7.

    Article  PubMed  Google Scholar 

  46. de Luis DA, Pacheco D, Izaola O, Terroba MC, Cuellar L, Martin T. Zinc and copper serum levels of morbidly obese patients before and after biliopancreatic diversion: 4 years of follow-up. J Gastrointest Surg. 2011;15(12):2178–81.

    Article  PubMed  Google Scholar 

  47. Ernst B, Thurnheer M, Schmid SM, Wilms B, Schultes B. Seasonal variation in the deficiency of 25-hydroxyvitamin D(3) in mildly to extremely obese subjects. Obes Surg. 2009;19(2):180–3.

    Article  PubMed  Google Scholar 

  48. Sallé A, Demarsy D, Poirier AL, Lelièvre B, Topart P, Guilloteau G, Bécouarn G, Rohmer V. Zinc deficiency: a frequent and underestimated complication after bariatric surgery. Obes Surg. 2010;20(12):1660–70.

    Article  PubMed  Google Scholar 

  49. 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 

  50. 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 

  51. Slater GH, Ren CJ, Siegel N, Williams T, Barr D, Wolfe B, Dolan K, Fielding GA. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004;8(1):48–55. discussion 54-5

    Article  PubMed  Google Scholar 

  52. de Luis DA, Pacheco D, Izaola O, Terroba MC, Cuellar L, Martin T. Clinical results and nutritional consequences of biliopancreatic diversion: three years of follow-up. Ann Nutr Metab. 2008;53(3–4):234–9.

    Article  PubMed  Google Scholar 

  53. Balsa JA, Botella-Carretero JI, Gómez-Martín JM, Peromingo R, Arrieta F, Santiuste C, Zamarrón I, Vázquez C. 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 

  54. Saif T, Strain GW, Dakin G, Gagner M, Costa R, Pomp A. Evaluation of nutrient status after laparoscopic sleeve gastrectomy 1, 3, and 5 years after surgery. Surg Obes Relat Dis. 2012;8(5):542–7.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Rosa FT, de Oliveira-Penaforte FR, de Arruda Leme I, Padovan GJ, Ceneviva R, Marchini JS. Altered plasma response to zinc and iron tolerance test after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2011;7(3):309–14.

    Article  PubMed  Google Scholar 

  56. Ruz M, Carrasco F, Rojas P, Codoceo J, Inostroza J, Basfi-fer K, Csendes A, Papapietro K, Pizarro F, Olivares M, Sian L, Westcott JL, Miller LV, Hambidge KM, Krebs NF. Zinc absorption and zinc status are reduced after Roux-en-Y gastric bypass: a randomized study using 2 supplements. Am J Clin Nutr. 2011 Oct;94(4):1004–11.

    Article  CAS  PubMed  Google Scholar 

  57. O’Donnell KB, Simmons M. Early-onset copper deficiency following Roux-en-Y gastric bypass. Nutr Clin Pract. 2011 Feb;26(1):66–9.

    Article  PubMed  Google Scholar 

  58. Yarandi SS, Griffith DP, Sharma R, Mohan A, Zhao VM, Ziegler TR. Optic neuropathy, myelopathy, anemia, and neutropenia caused by acquired copper deficiency after gastric bypass surgery. J Clin Gastroenterol. 2014;48(10):862–5.

    CAS  PubMed  Google Scholar 

  59. Coupaye M, Puchaux K, Bogard C, Msika S, Jouet P, Clerici C, Larger E, Ledoux S. Nutritional consequences of adjustable gastric banding and gastric bypass: a 1-year prospective study. Obes Surg. 2009;19(1):56–65.

    Article  PubMed  Google Scholar 

  60. Gasteyger C, Suter M, Gaillard RC, Giusti V. Nutritional deficiencies after roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008;87(5):1128–33.

    Article  CAS  PubMed  Google Scholar 

  61. Koffman BM, Greenfield LJ, Ali II, Pirzada NA. Neurologic complications after surgery for obesity. Muscle Nerve. 2006;33:166–76.

    Article  PubMed  Google Scholar 

  62. Ramos-Leví AMR, Sánchez-Pernaute A, Herrera MAR. Dermatitis and optic neuropathy due to zinc deficiency after malabsorptive bariatric surgery. Nutr Hosp. 2013;28(4):1345–7.

    PubMed  Google Scholar 

  63. KG MD Jr, Long SD, Swanson MS, Brown BM, Morris P, Dohm GL, Pories WJ. The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus. J Gastrointest Surg. 1997;1(3):213–20.

    Article  Google Scholar 

  64. Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, Lamonte MJ, Stroup AM, Hunt SC. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.

    Article  CAS  PubMed  Google Scholar 

  65. Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, Bengtsson C, Dahlgren S, Gummesson A, Jacobson P, Karlsson J, Lindroos AK, Lönroth H, Näslund I, Olbers T, Stenlöf K, Torgerson J, Agren G, Carlsson LM, Study SOS. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.

    Article  PubMed  Google Scholar 

  66. Fouse T, Brethauer S. Resolution of comorbidities and impact on longevity following bariatric and metabolic surgery. Surg Clin North Am. 2016;96(4):717–32.

    Article  PubMed  Google Scholar 

  67. Sjöström L, Gummesson A, Sjöström CD, Narbro K, Peltonen M, Wedel H, Bengtsson C, Bouchard C, Carlsson B, Dahlgren S, Jacobson P, Karason K, Karlsson J, Larsson B, Lindroos AK, Lönroth H, Näslund I, Olbers T, Stenlöf K, Torgerson J, Carlsson LM, Study SOS. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish obese subjects study): a prospective, controlled intervention trial. Lancet Oncol. 2009;10(7):653–62.

    Article  PubMed  Google Scholar 

  68. Adams TD, Stroup AM, Gress RE, Adams KF, Calle EE, Smith SC, Halverson RC, Simper SC, Hopkins PN, Hunt SC. Cancer incidence and mortality after gastric bypass surgery. Obesity (Silver Spring). 2009;17(4):796–802.

    Article  Google Scholar 

  69. Christou NV, Lieberman M, Sampalis F, Sampalis JS. Bariatric surgery reduces cancer risk in morbidly obese patients. Surg Obes Relat Dis. 2008;4(6):691–5.

    Article  PubMed  Google Scholar 

  70. Casagrande DS, Rosa DD, Umpierre D, Sarmento RA, Rodrigues CG, Schaan BD. Incidence of cancer following bariatric surgery: systematic review and meta-analysis. Obes Surg. 2014;24(9):1499–509.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil

    Milene Amarante Pufal

  2. Department of Surgery, Stony Brook University, Stony Brook, NY, USA

    Konstantinos Spaniolas

Authors
  1. Milene Amarante Pufal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Konstantinos Spaniolas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Milene Amarante Pufal .

Editor information

Editors and Affiliations

  1. Foregut and Bariatric Surgeon, Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA

    Kevin M. Reavis

  2. Long Island Jewish Forest Hills Hospital, Department of Surgery, Hofstra-Northwell School of Medicine, Forest Hills, New York, USA

    Allison M. Barrett

  3. Institute Chief, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

    Matthew D. Kroh

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Pufal, M.A., Spaniolas, K. (2018). Long-Term Nutritional/Metabolic Sequelae of Bariatric Surgery. In: Reavis, K., Barrett, A., Kroh, M. (eds) The SAGES Manual of Bariatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-71282-6_26

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-71282-6_26

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-71281-9

  • Online ISBN: 978-3-319-71282-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation