Laparoscopic Gastric Sleeve and Micronutrients Supplementation: Our Experience

Abstract

Background. Laparoscopic gastric sleeve (LGS) has been recently introduced as a stand-alone, restrictive bariatric surgery. Theoretically, LGS attenuates micronutrients deficiencies and associated complications that were typically observed following malabsorptive procedures. The aim of this study was to assess some micronutrients and mineral deficiencies in patients undergoing LGS. Methods. In the period between July 2008 and April 2010, 138 obese patients (110 females and 28 males) with mean BMI 44.4 kg/m2 ± 6.5, mean age 43.9 ± 10.9 years were enrolled and underwent LGS. Patients were followed up with routine laboratory tests and anthropometric measurements and assessed for nutritional status, as regards vitamin B12, folic acid, iron, hemoglobin, calcium, and vitamin D, every three months throughout 12 months. Results. 12 months after sleeve, patients did not show iron deficiency and/or anemia; plasma calcium levels were in the normal range without supplementation from the sixth month after the operation. Vitamin B12 and folic acid were adequately supplemented for all the follow-up period. Vitamin D was in suboptimal levels, despite daily multivitamin supplementation. Conclusion. In this study, we showed that LGS is an effective surgery for the management of morbid obesity. An adequate supplementation is important to avoid micronutrients deficiencies and greater weight loss does not require higher dosage of multivitamins.

Hypovitaminosis D in bariatric surgery: A systematic review of observational studies

“…Thirteen studies showed a mean 25(OH)D level < 20 ng/ml at 6 months to 11 years post operatively [51,54,55,64,78,85–92]. The remaining studies, almost half, reported a 25(OH)D level between 20 and 30 ng/ml [53,56–59,62,67–71,76,77,79,93–100]. …”

“…Furthermore, 25(OH)D level did not change [67,68,76] or even decreased [64,72,78] in several studies at one year follow up, despite supplementation (equivalent daily dose range 200–800 IU) (Figure 3, Appendix). Avgerinos et al showed an initial increase followed by a drastic decrease in 25(OH)D level at 1 year following RYGB, despite sustained vitamin D supplementation of 800 IU daily; findings that remain unexplained [80].…”

“…Three studies conducted on patients undergoing laparoscopic sleeve gastrectomy (LSG) surgery suggest that a vitamin D dose less than 1,000 IU/d may not be sufficient to raise mean levels to above the desirable value of 20 ng/ml, even in restrictive procedures [76,81,90]. …”

“…Studies of malabsorptive or combination procedures, with supplementation up to 2,000 IU of vitamin D daily, achieved mean 25(OH)D levels at or above 20 ng/ml, provided mean levels did not start below such cutoff pre-operatively [67,68,70,71,76,79,80,90,94,104]. When baseline 25(OH)D level was < 20 ng/ml, three studies showed an increase in mean 25(OH)D level to above the target [57,58,63], while three others did not [51,64,78].…”

16 Laparoscopic Sleeve Gastrectomy: Management of Complications

“…It has been suggested that LSG has a minimal impact on macronutrients as it does not alter the site of their absorption in the small intestine [ 39 ]. Gehrer et al compared the nutritional defi ciencies occurring after LSG and laparoscopic RYGB and observed nutritional defi ciencies in 57 % of patients.…”