Nutrition Bariatric Surgery and Nutritional

Nutrition

Bariatric Surgery and Nutritional Consequences

The prevalence of obesity is on its way up and is often associated with a number of co-morbidities, including type 2 diabetes mellitus, coronary heart disease, hyperlipidemia, hypertension, sleep apnea, pulmonary dysfunction, ischemic stroke, knee arthrosis, gallbladder disease, nonalcoholic steatohepatitis and certain types of cancer. Bariatric surgery has been shown to be the most successful long-term treatment for morbid obesity, reducing obesity-associated co-morbidities (De Luis et al., 2009). But for all the good that it brings it can lead to serious nutritional deficiencies in those who undergo it.

Biliopancreatic diversion (BPD) is a mixed and complex operation that has shown the best long-term results regarding weight loss. BPD can be considered a very good bariatric operation. It is well-known that as difficulty increases in bariatric surgery, effectiveness also increases, but risk of secondary effects and possible complications may also go up. A good knowledge of this technique in early follow-up and of its possible complications is important for the patients. The severity of the postoperative nutritional deficit depends on several factors, including the preoperative nutritional status, the type of bariatric procedure performed, the incidence of postoperative complications, the capability to modify eating behavior as well as conformity with regular follow-up and prescribed vitamin and mineral supplementation (De Luis et al., 2009).

In a study done by De Luis et al. (2009) the researchers set out to describe clinical results and nutritional complications in morbidly obese patients with BPD. The results showed a high loss of body weight and an improvement in the prevalence of co-morbidities in patients having undergone BPD. However, blood levels of a number of micronutrients and vitamins decreased during the follow-up and different rates of deficiencies were detected.

Loss of weight in the patients was important, amounting to 29.3% at 6 months and 61.5% at 3 years of follow-up.

The most frequent side event found was incisional hernia, related to open surgery and high BMI. In previous studies, the incisional hernia rate has ranged from 5 to 30%. Glycemia, plasma lipid levels and blood pressure became normal 6 months after BPD, while patients were still overweight. All the patients could quit their hypoglycemic and hypolipemic drugs. With other type of bariatric surgery, such as gastric bypass, depending on the intestinal length, the normalization of these parameters is lower. This type of surgery has been shown to have a direct effect on glycemic status (De Luis et al., 2009)

In is well-known that bariatric surgery often leads to patients experiencing long-term side effects that negatively influence their metabolism and quality of life. These side effects include: vomiting, diarrhea, osteoporosis, anemia and malnutrition. All of these side effects either lead to nutritional deficiencies or are consequences of such deficiencies. Bariatric surgeons have long wanted to find an operation that result in steady weigh loss that was simple, had only minimal risk and gave the patients the freedom to consume most foods in order to maintain nutritional sufficiency (Vassallo et al., 2010).

The Long Magenstrasse with pyloroplasty as functional Gastric Bypass (LMGBP) procedure is that such surgery. This surgery has been found to reduce the occurrence of side effects connected with gastric restrictive and malabsorptive surgery, particularly on quality of life and long-term nutritional insufficiency. This surgery has shown to result in significant weight loss, together with its moderate surgical risk, very low complication profile, and the satisfaction of patients. This suggests that is might be a feasible advance in bariatric surgical technique. This procedure can be employed to advantage and perhaps may be preferable to the technically more complex RYGBP, which is not without nutritional-metabolic side effects (Vassallo, 2010). The goal is to limit the nutritional deficiencies as much as possible.

In a study done by Vassallo et al. (2010), the researchers set out to confirm that patients undergoing LMGBP had safe and effective weight loss with conjunction with excellent reduction or resolution of co-morbidities of obesity, few and mild complication in the peri operative period and long-term, and in improved quality of life for patients.

This study found that that the patients undergoing LMGBP do not become a formerly morbidly obese patient, but rather, a person whose metabolism functions more like that of a normal-weight individual. This form of functional gastric bypass appears to achieve and maintain weight loss safely without marked nutritional deficiencies, and without the psychological and behavioral strain of treating the nutritional imbalances that frequently accompany restrictive or malabsorptive surgery (Vassallo et al., 2010).