Background

Recently, the laparoscopic sleeve gastrectomy (LSG) has become popular as a single-stage procedure for the treatment of morbid obesity and its co-morbidities. However, the incidence of micronutrient deficiencies after LSG have hardly been researched.

Methods

From January 2005 to October 2008, 60 patients underwent LSG. All patients were instructed to take daily vitamin supplements. Patients were tested for micronutrient deficiencies 6 and 12 months after surgery.

Results

Anemia was diagnosed in 14 (26%) patients. Iron, folic acid, and vitamin B12 deficiency was found in 23 (43%), eight (15%), and five (9%) patients, respectively. Vitamin D and albumin deficiency was diagnosed in 21 (39%) and eight (15%) patients. Hypervitaminosis A, B1, and B6 were diagnosed in 26 (48%), 17 (31%), and 13 (30%) patients, respectively.

Conclusions

Due to inadequate intake and uptake of micronutrients, patients who underwent LSG are at serious risk for developing micronutrient deficiencies. Moreover, some vitamins seem to increase to chronic elevated levels with possible complications in the long-term. Multivitamins and calcium tablets should be regarded only as a minimum and supplements especially for iron, vitamin B12, vitamin D, and calcium should be added to this regimen based on regular blood testing.

Introduction

A laparoscopic sleeve gastrectomy (LSG) is often used as a first-stage procedure followed either by Laparoscopic Roux-en-Y gastric bypass (LRYGB) or duodenal switch (DS). LSG is performed to obtain weight loss and co-morbidity reduction by restricting the food capacity of the stomach. Currently, LSG is performed less often than laparoscopic gastric banding and LRYGB, but reports of LSG used as a single procedure in morbidly obese patients are increasing.

Deficiencies in micronutrients after bariatric procedures are a known threat if not corrected appropriately. Surprisingly, reports on anemia and micronutrient deficiencies specifically in patients who underwent LSG are scarce. As part of our standard follow-up care, we conducted this prospective study to evaluate the deficiencies in the first year following LSG.

Patients and Methods

From January 2005 to October 2008, 60 morbidly obese patients were treated with an LSG by two surgeons as a first-stage procedure towards a DS. This group of patients consisted of 36 males and 24 females with a mean age of 44 (18–70) years. Mean initial weight and body mass index (BMI) were 178 (±33.9) kg and 56.8 (±10.9) kg/m2, respectively. Demographics are shown in Table 1.

Table 1

Demographics

Parameter

Values (Standard deviation)

Number of patients

60

Male

34 (56.6%)

Female

26 (43.3%)

Age

43.6 (18–70)

Initial weight, kg

178.4 (±33.9)

Initial BMI, kg/m2

56.8 (±10.9)

All patients underwent a LSG as a first step in order to reduce operative risks (ASA score) of the DS in the second stage. In our clinic, the gastric volume is reduced by stapling the gastric fundus and greater curvature parallel to a 36 French boogie, which is inserted in the stomach through the esophagus. Stapling starts from a distance of 3 to 5 cm from the pylorus at the greater curvature side towards the angle of His. This results in a tube-like stomach made from the lesser curvature only.

Standard laboratory evaluation was performed preoperatively consisting of a complete blood count, a mean cell volume (MCV) and kidney function. Results are shown in Table 2. After 6 and 12 months, the laboratory evaluation was repeated along with plasma iron, total iron binding capacity (TIBC), calcium, serum calcidiol (vitamin D3), parathyroid (PTH), serum retinol (vitamin A), serum thiamin (vitamin B1), serum pyridoxine (vitamin B6), serum folate (vitamin B11), and serum cobalamin (vitamin B12).

Table 2

Preoperative laboratory outcomes

Level

Number of patients (%)

Hb

Low

5 (8.3%) of which 1 was microcytic

Normal

55 (91.7%) of which 2 were microcytic

MCV

Microcytic

3 (5.0%)

Normocytic

57 (95.0%)

Macrocytic

0 (0%)

Patients were instructed to take multivitamin tablets three times daily (150% RDA). Other postoperative medication consisted of a CaD 1000/880® sachet for 1 year to prevent bone loss, Omeprazol® 40 mg once daily for 6 months to prevent ulceration of the staple lines and the remaining stomach and 5700U of Fraxiparine® once daily for 6 weeks postoperatively to prevent thrombosis.

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