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Post- Op Bariatric Surgery — Learn How to Identify Red Flags and Triage Nutritional Deficiencies. November 2. 01. 2 Issue. Post- Op Bariatric Surgery — Learn How to Identify Red Flags and Triage Nutritional Deficiencies. By Margaret M. 5. Suggested CDR Learning Codes: 2. Level 2. Take this course and earn 2 CEUs on our Continuing Education Learning Library. Obesity is a complex, multifactorial disease that has genetic, biological, and environmental origins.
While traditional treatment has involved counseling individuals to restrict calories and make lifestyle changes, such as eating a nutrient- dense diet, participating in regular physical activity, and other behavior modifications, many people classified as severely obese (BMI of 4. In the United States, more than one- third of adults aged 2.
I am a certified fitness specialist through the American College of Spots Medicine and an. During your first four weeks following surgery, you will need to adhere to a diet beginning with liquids only and progressing to soft pureed foods. We have all heard that some nausea and vomiting may be common following your bariatric surgery, but there are some things you can do to lessen these side effects.
Protein powders and shakes are a staple on the pre-op weight loss and post-op recovery diet. Delicious protein shakes, smoothies, drinks and concentrates for pre-op. After Gastric Sleeve / Bypass Diet. These are general guidelines regarding when to introduce various foods. Everyone is different and may not progress at the same rate. THE BARIATRIC SURGERY BLOG. Real Stories. Real Advice. Real Patients.
BMI of 3. 0 or greater). It’s been estimated that the rate of severe obesity is rapidly increasing. Between 2. 00. 0 and 2. BMI of 4. 0 or greater and a BMI of 5. These climbing rates show traditional weight- loss modalities have failed to provide long- term solutions. In fact, studies have found that bariatric surgery is the only modality that leads to permanent, significant weight loss and the reduction of comorbidities for the vast majority of individuals who have severe obesity. These results appear to be the impetus for the growing popularity of bariatric surgery.
In 2. 00. 9 alone, it was estimated that 2. Medicare and private insurance companies increasingly provide reimbursement for these procedures, these numbers may grow. Because more and more people are choosing weight- loss surgery, it will be of greater importance for dietitians to educate themselves about the different types of bariatric procedures and how to care for the unique nutritional needs of these patients. This continuing education course will discuss the various bariatric surgical procedures as well as the most common nutritional deficiencies in patients before and after surgery and strategies to treat them.
Need for Nutrition Guidelines. With the ever- increasing prevalence of bariatric surgery, a greater need for evidence- based nutrition guidelines is apparent. More dietitians are asking questions about the procedures and how to effectively counsel patients. Many RDs are seeing bariatric surgery patients for the first time in their practices and may not fully understand the procedures or what are appropriate questions to ask clients. The good news is that there are guidelines RDs and other healthcare professionals can follow. In 2. 00. 8, the American Society for Metabolic and Bariatric Surgery (ASMBS) published allied health nutrition guidelines for bariatric surgery patients who have undergone Roux- en- Y gastric bypass, adjustable gastric banding, and biliopancreatic diversion (BPD) with and without duodenal switch. The ASMBS plans to update these guidelines to include a discussion of the gastric sleeve procedure, an increasingly popular bariatric surgical technique.
Until then, health professionals should rely on the latest reports in the scientific literature for guidance. Types of Procedures. The bariatric procedures performed in the United States fall under the terms “restrictive,”1. Therefore, this article will use the terms restrictive and malabsorptive to describe these procedures. Purely Restrictive.
This surgical technique involves adjustable gastric banding. Those who continuously snack throughout the day, however, may not benefit because they’re more likely to eat unhealthful foods, such as crackers, pretzels, and ice cream that can easily slide through the band, preventing them from sustaining long- term weight loss. The vertical sleeve gastrectomy procedure, also known as “the sleeve,” involves the removal of approximately 8. A decrease in ghrelin may cause a reduction in hunger for approximately six months after surgery. Some experts perceive this procedure as purely restrictive in nature, while others consider it “mainly restrictive”1.
B1. 2. Unlike the Roux- en- Y gastric bypass and the BPD with or without duodenal switch, the sleeve doesn’t involve the small intestines, making it a more restrictive procedure. The sleeve also doesn’t involve bypassing the duodenum, although there are reports that it can cause vitamin and mineral deficiencies, which may be due to the decrease in the production of intrinsic factor. But long- term data (greater than five years) is lacking. The sleeve was originally designed to be the initial surgery for high- risk patients and people with a BMI greater than 5. Once these patients lose a significant amount of weight, reducing the risks associated with more complex procedures, they would then undergo BPD or BPD with duodenal switch, or the Roux- en- Y gastric bypass. The sleeve technique recently was introduced as a stand- alone bariatric procedure because the short- term outcomes of weight loss and positive impact on comorbidities were significant. The sleeve also decreases the risk of micronutrient deficiencies and associated complications linked with the Roux- en- Y gastric bypass and BPD procedures.
Restrictive Malabsorptive. Roux- en- Y gastric bypass is a restrictive- malabsorptive technique considered the “gold standard” for weight- loss surgery in the United States. Following this procedure, gastric capacity is reduced by 9. This limb drains bile, digestive enzymes, and gastric secretions to assist digestion and absorption further down the alimentary tract.
During surgery, the proximal to midend of the jejunum is anastomosed to the gastric pouch. Less commonly, the distal end of the jejunum is anastomosed to the gastric pouch for greater malabsorption. This creates the common limb.
After gastric bypass surgery, the food and enzymes ingested are mixed only in the small area of the common limb, compromising absorption of certain nutrients. Many in the medical community believe macronutrients are malabsorbed after gastric bypass surgery as they are with the BPD or BPD with duodenal switch procedure, while others say this isn’t the case.
Primarily, research shows that micronutrients are malabsorbed following gastric bypass surgery, leading to micronutrient deficiencies in patients. Malabsorptive. The BPD with or without duodenal switch comprises this category of bariatric surgery. Each has only a minimal restrictive component that involves the creation of a sleevelike stomach. In 1. 97. 6, Professor Nicola Scopinaro of Italy introduced the BPD procedure, which involved the creation of a 2.
L proximal gastric pouch and removal of 6. The creation of a 2. To lower the risk of fat malabsorption and other side effects, the BPD with duodenal switch was introduced. De. Meester and Hinder.
The potential advantages of BPD with duodenal switch over Roux- en- Y gastric bypass include a decreased incidence of marginal ulceration, vagal innervation, and the preservation of antropyloric function, which reduces the risk of dumping syndrome as seen in at least 5. Roux- en- Y gastric bypass patients. Although many people define dumping syndrome as vomiting or diarrhea, it more likely resembles common symptoms associated with hypoglycemia, such as dizziness or lightheadedness, sweating, nausea, and lethargy, which may last 3. Many people report feeling lethargic and/or nauseated for several hours but this varies. Dumping syndrome is believed to occur in about 5. The absence of the pylorus and pyloric valve as well as the duodenum prevent the body from diluting concentrated foods and may be a significant factor in the occurrence of dumping syndrome. Common Post- Op Micronutrient Deficiencies.
Bariatric procedures that involve techniques to reduce gastric capacity or reroute the intestines to the gastric pouch may lead to micronutrient deficiencies. Micronutrients are malabsorbed following gastric bypass surgery and BPD with or without duodenal switch. It’s estimated that BPD with or without duodenal switch can cause a 2. Vitamins and minerals that depend on fat absorption for optimal bioavailability, such as vitamins A, D, E, and K and zinc, won’t be fully absorbed. Moreover, the delay in gastrointestinal transit time may increase the risk of many other micronutrient deficiencies, including iron, calcium, vitamin B1. But micronutrient deficiencies not only affect postsurgery patients; they can affect severely obese individuals known for their high intake of macronutrients.
For example, a patient seeking adjustable gastric banding surgery may present with many vitamin and mineral deficiencies that can be exacerbated after surgery. Purely restrictive procedures, such as gastric banding, may result in micronutrient deficiencies related to changes in dietary intake or vomiting. The following are some of the most common micronutrient deficiencies and symptoms patients experience after bariatric surgery and strategies for treatment. Thiamin. Vitamin B1, also called thiamin or thiamine, is one of eight B vitamins that assist the body in converting food (carbohydrates) into fuel (glucose) and is used to produce energy for the body. Thiamin and the B complex vitamins assist in fat and protein metabolism and proper functioning of the brain and nervous system and are essential for healthy skin, hair, eyes, and liver.
Bariatric surgery can exacerbate or increase the risk of thiamin deficiency and lead to beriberi, a disease caused by a lack of thiamin. Early diagnosis of signs and symptoms is extremely important. Gastric banding patients also may be at risk, particularly if they experience intractable vomiting because thiamin has a short half- life, meaning that thiamin stores last only a few days in the body. Untreated thiamin deficiency may lead to Wernicke’s encephalopathy, a syndrome characterized by visual abnormalities such as nystagmus and lid ptosis, ataxia, peripheral neuropathy, memory loss, confusion, apathy, disorientation and, in some cases, death. IV infusions of thiamine with dextrose are recommended to treat patients with thiamin deficiency.
Roux- En- Y Gastric Bypass Surgery and Recovery. Surgery Overview. Gastric bypass surgery makes the stomach smaller and causes food to bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size. This reduces the amount of food you can eat at one time. Bypassing part of the intestine reduces how much food and nutrients are absorbed. This leads to weight loss.
One type of gastric bypass surgery is a Roux- en- Y gastric bypass. In normal digestion, food passes through the stomach and enters the small intestine, where most of the nutrients and calories are absorbed. It then passes into the large intestine (colon), and the remaining waste is eventually excreted.
In a Roux- en- Y gastric bypass, only a small part of the stomach is used to create a new stomach pouch, roughly the size of an egg. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum). This procedure is done by making several small incisions and using small instruments and a camera to guide the surgery (laparoscopic approach).
What To Expect After Surgery. You will have some belly pain and may need pain medicine for the first week or so after surgery. The cut that the doctor makes (incision) may be tender and sore. Because the surgery makes your stomach smaller, you will get full more quickly when you eat.
Food also may empty into the small intestine too quickly and lead to dumping syndrome. This can cause diarrhea and make you feel faint, shaky, and nauseated.
It also can make it hard for your body to get enough nutrition. Your doctor will give you specific instructions about what to eat after the surgery. For about the first month after surgery, your stomach can only handle small amounts of soft foods and liquids while you are healing.
It is important to try to sip water throughout the day to avoid becoming dehydrated. You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. Bit by bit, you will be able to add solid foods back into your diet.
You must be careful to chew food well and to stop eating when you feel full. This can take some getting used to, because you will feel full after eating much less food than you are used to eating. If you do not chew your food well or do not stop eating soon enough, you may feel discomfort or nausea and may sometimes vomit. If you drink a lot of high- calorie liquid such as soda or fruit juice, you may not lose weight. If you continually overeat, the stomach may stretch. If your stomach stretches, you will not benefit from your surgery.
In a gastric bypass, the part of the intestine where many minerals and vitamins are most easily absorbed is bypassed. Because of this, you may have a deficiency in iron, calcium, magnesium, or vitamins. This can lead to long- term problems, such as osteoporosis. To prevent vitamin and mineral deficiencies, you may need to work with a dietitian to plan meals. And you may need to take extra vitamin B1.
Depending on how the surgery was done (open or laparoscopic), you'll have to watch your activity during recovery. If you had open surgery, it is important to avoid heavy lifting or strenuous exercise while you are recovering so that your belly can heal. In this case, you will probably be able to return to work or your normal routine in 4 to 6 weeks. The surgery is most commonly done as a laparoscopic procedure, which means the recovery time is faster. Why It Is Done. Weight- loss surgery is suitable for people who are severely overweight and who have not been able to lose weight with diet, exercise, or medicine.
Surgery is generally considered when your body mass index (BMI) is 4. Surgery may also be an option when your BMI is 3. It is important to think of this surgery as a tool to help you lose weight. It is not an instant fix. You will still need to eat a healthy diet and get regular exercise.
This will help you reach your weight goal and avoid regaining the weight you lose. How Well It Works.
On average, people lose more than half of their excess weight following Roux- en- Y surgery. Ten years after weight- loss surgery, many people have gained 2.
The long- term success is highest in people who are realistic about how much weight will be lost and who keep appointments with a medical team, follow the recommended eating plan, and are physically active. Risks. Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity or where the intestine is connected (resulting in an infection called peritonitis), and a blood clot in the legs (deep vein thrombosis, or DVT) or lung (pulmonary embolism). Some people develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis. Other risks from Roux- en- Y gastric bypass include: Stomach pouch problems.
You may need a repeat surgery to repair the stomach and/or the opening between the stomach and the intestine. Vomiting. If you eat more than your stomach can hold, you may vomit. These can be related to the incisions that the surgeon makes or caused by the intestine twisting around itself. Kidney stones. Drinking enough water can help.
Gallstones. Sometimes the gallbladder is removed as part of the surgery. But if your gallbladder is not removed, then you may need to take medicine to prevent gallstones. What To Think About Weight- loss surgery does not remove fatty tissue. It is not cosmetic surgery. Some studies show that people who have weight- loss surgery are less likely to die from heart problems, diabetes, or cancer compared to obese people who did not have the surgery. Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery. References. Citations.
Heber D, et al. Endocrine and nutritional management of the post- bariatric surgery patient: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 9. Available online: http: //www. FINAL- Standalone- Post- Bariatric- Surgery- Guideline- Color. Adams TD, et al. Long- term mortality after gastric bypass surgery.
New England Journal of Medicine, 3. Other Works Consulted. Colquitt JL, et al. Cochrane Database of Systematic Reviews (2).
Credits. By. Healthwise Staff. Primary Medical Reviewer. E. Gregory Thompson, MD - Internal Medicine. Specialist Medical Reviewer.
Ali Tavakkoli, FACS, FRCS, MD - General Surgery, Bariatric Surgery. Current as of. February 2.