SLIDE 19 19 | [footer text here]
Bypass Sleeve
leak (1-2%) treatment: reoperation or drainage procedure with feeding tube placement staple line leak (0.5-%) treatment: reoperation, stent placement, feeding tube placement, drain placement, or some combination thereof stricture of gastrojejunostomy (2-3%) treatment: dilation during endoscopy sleeve stricture (1-4%) treatment: reoperation, conversion to gastric bypass marginal ulceration (3-5%) treatment: antacids, surgery in rare cases gallstone disease (2% with prevention) prevention: ursodiol for 6 months treatment: remove gallbladder gallstone disease (2% with prevention) prevention: ursodiol for 6 months treatment: remove gallbladder gastroesophageal reflux (20-50%) treatment: acid blocking medications. (conversion to gastric bypass in extreme cases) internal hernias / obstruction (1-5%) treatment: surgery in most cases dumping syndrome (0-10%) treatment: limit simple sugars, high protein diet, complex carbs, high fiber, smaller more frequent meals dumping syndrome (0-10%) treatment: limit simple sugars, high protein diet, complex carbs, high fiber, smaller more frequent meals
LATE REOPERATION (5%) LATE REOPERATION (3% - 10%)
Nutritional Deficiencies after Gastric Bypass Surgery
Nutrient
Risk of deficiency Diagnosis Treatment
Protein
<5% Hypoalbuminemia Dietary diary <60g Prophy: dietary training >60g Rx: Protein shakes
Calcium / vitamin D
0.9% hypocalcemia 30% secondary HPTH Serum calcium Serum PTH Vitamin D level Prophy: Ca 500mg + vit D 200IU TID Rx: vit D 100,000 IU IM weekly until 25-OHD levels normalize
Essential fatty acids
Rare Dry scaly skin, hair loss Triene:tetraene ratio >0.2 Prophy: soy protein Rx: soy protein, safflower oil
Vits ADEK
Rare A - Night blindness E - Eczematous rash K - Coagulopathy D - Osteomalacia Rx: ADEK tablet daily vitamin A 4,000 IU vitamin D 400 IU vitamin E 150 IU vitamin K 0.15mg (also contains folate, thiamine, B vits)
Iron
Up to 50% of women without supplements Anemia Prophy: FeSO4 325mg daily + vit C Rx: mild: FeSO4 TID severe: Iron dextran IV
Vitamin B12
Up to 33% if only taking multivitamin Anemia Neuropathy Prophy: vit B12 500ug SL daily Rx: 1000uG IM monthly until normal
Folate
Rare if taking MVI Hyperhomocysteinemia Anemia Neural tube defects of preg Prophy: MVI Rx: folate acid supplementation
Thiamine (vit B1)
Rare, unless severe nausea and vomiting Wernicke-Korsakoff Peripheral neuropathy Beriberi <erythrocyte transketolase activity Prophy: MVI Rx: thiamine 100mg/day IV
courtesy of ASMBS
Metabolic benefits
bariatric surgery
courtesy of ASMBS
Metabolic benefits
bariatric surgery
