Medical management of patients after bariatric surgery: Principles and guidelines

Abd Elrazek Mohammad Ali Abd Elrazek, Abduh Elsayed Mohamed Elbanna, Shymaa E Bilasy, Abd Elrazek Mohammad Ali Abd Elrazek, Abduh Elsayed Mohamed Elbanna, Shymaa E Bilasy

Abstract

Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index (BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients (BMI ≥ 30 kg/m(2)) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m(2) and those with BMI > 35 kg/m(2) with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.

Keywords: Bariatric surgery; Body-mass index; El banna; Obesity; Postoperative care.

Figures

Figure 1
Figure 1
Male to female prevalence in different countries worldwide.
Figure 2
Figure 2
Schematic presentation of sleeve gastrectomy.
Figure 3
Figure 3
Schematic presentation of Roux-in Y Gastrectomy.
Figure 4
Figure 4
Schematic presentation of adjustable gastric band.
Figure 5
Figure 5
Novel ElBanna surgical procedure.

References

    1. Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, Thomas S, Abood B, Nissen SE, Bhatt DL. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–1576.
    1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–781.
    1. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJ. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet. 2010;375:1609–1623.
    1. Rajaratnam JK, Marcus JR, Flaxman AD, Wang H, Levin-Rector A, Dwyer L, Costa M, Lopez AD, Murray CJ. Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: a systematic analysis of progress towards Millennium Development Goal 4. Lancet. 2010;375:1988–2008.
    1. Bleich S, Cutler D, Murray C, Adams A. Why is the developed world obese? Annu Rev Public Health. 2008;29:273–295.
    1. Food and Agriculture Organization Corporate Statistical Database. Food balance sheets. Available from: .
    1. UN Department of Economic and Social Affairs, Population Division. World population prospects: the 2010 revision. Volume 1: Comprehensive tables. New York: United Nations; 2011.
    1. Astrup A, Brand-Miller J. Diet composition and obesity. Lancet. 2012;379:1100; author reply 1100–1101.
    1. Drewnowski A, Popkin BM. The nutrition transition: new trends in the global diet. Nutr Rev. 1997;55:31–43.
    1. Briefel RR, Johnson CL. Secular trends in dietary intake in the United States. Annu Rev Nutr. 2004;24:401–431.
    1. Swinburn B, Sacks G, Ravussin E. Increased food energy supply is more than sufficient to explain the US epidemic of obesity. Am J Clin Nutr. 2009;90:1453–1456.
    1. Popkin BM. The nutrition transition and obesity in the developing world. J Nutr. 2001;131:871S–873S.
    1. Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, Wollum A, Sanman E, Wulf S, Lopez AD, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA. 2014;311:183–192.
    1. Ben-Menachem T. Risk factors for cholangiocarcinoma. Eur J Gastroenterol Hepatol. 2007;19:615–617.
    1. Younossi ZM, Stepanova M, Negro F, Hallaji S, Younossi Y, Lam B, Srishord M. Nonalcoholic fatty liver disease in lean individuals in the United States. Medicine (Baltimore) 2012;91:319–327.
    1. American Society for Metabolic and Bariatric Surgery. Fact Sheet: Metabolic and Bariatric Surgery. Available from: .
    1. Nguyen NT, Masoomi H, Magno CP, Nguyen XM, Laugenour K, Lane J. Trends in use of bariatric surgery, 2003-2008. J Am Coll Surg. 2011;213:261–266.
    1. Dimick JB, Nicholas LH, Ryan AM, Thumma JR, Birkmeyer JD. Bariatric surgery complications before vs after implementation of a national policy restricting coverage to centers of excellence. JAMA. 2013;309:792–799.
    1. Chen KN. Managing complications I: leaks, strictures, emptying, reflux, chylothorax. J Thorac Dis. 2014;6 Suppl 3:S355–S363.
    1. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, Heinberg LJ, Kushner R, Adams TD, Shikora S, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & amp; Bariatric Surgery. Obesity (Silver Spring) 2013;21 Suppl 1:S1–27.
    1. Tucker ON, Szomstein S, Rosenthal RJ. Nutritional consequences of weight-loss surgery. Med Clin North Am. 2007;91:499–514, xii.
    1. Sjöström L, Peltonen M, Jacobson P, Sjöström CD, Karason K, Wedel H, Ahlin S, Anveden Å, Bengtsson C, Bergmark G, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307:56–65.
    1. Bouldin MJ, Ross LA, Sumrall CD, Loustalot FV, Low AK, Land KK. The effect of obesity surgery on obesity comorbidity. Am J Med Sci. 2006;331:183–193.
    1. Schweiger C, Weiss R, Keidar A. Effect of different bariatric operations on food tolerance and quality of eating. Obes Surg. 2010;20:1393–1399.
    1. Ortega J, Ortega-Evangelio G, Cassinello N, Sebastia V. What are obese patients able to eat after Roux-en-Y gastric bypass? Obes Facts. 2012;5:339–348.
    1. Nelson WK, Fatima J, Houghton SG, Thompson GB, Kendrick ML, Mai JL, Kennel KA, Sarr MG. The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients. Surgery. 2006;140:517–522, discussion 522-523.
    1. Shen Z, Li Y, Yu C, Shen Y, Xu L, Xu C, Xu G. A cohort study of the effect of alcohol consumption and obesity on serum liver enzyme levels. Eur J Gastroenterol Hepatol. 2010;22:820–825.
    1. Koenig SM. Pulmonary complications of obesity. Am J Med Sci. 2001;321:249–279.
    1. Holes-Lewis KA, Malcolm R, O’Neil PM. Pharmacotherapy of obesity: clinical treatments and considerations. Am J Med Sci. 2013;345:284–288.
    1. Sakcak I, Avsar FM, Cosgun E, Yildiz BD. Management of concurrent cholelithiasis in gastric banding for morbid obesity. Eur J Gastroenterol Hepatol. 2011;23:766–769.
    1. Herrara MF, Lozano-Salazar RR, González-Barranco J, Rull JA. Diseases and problems secondary to massive obesity. Eur J Gastroenterol Hepatol. 1999;11:63–67.
    1. Lassailly G, Caiazzo R, Hollebecque A, Buob D, Leteurtre E, Arnalsteen L, Louvet A, Pigeyre M, Raverdy V, Verkindt H, et al. Validation of noninvasive biomarkers (FibroTest, SteatoTest, and NashTest) for prediction of liver injury in patients with morbid obesity. Eur J Gastroenterol Hepatol. 2011;23:499–506.
    1. Hofsø D, Nordstrand N, Johnson LK, Karlsen TI, Hager H, Jenssen T, Bollerslev J, Godang K, Sandbu R, Røislien J, et al. Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Endocrinol. 2010;163:735–745.
    1. Service GJ, Thompson GB, Service FJ, Andrews JC, Collazo-Clavell ML, Lloyd RV. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med. 2005;353:249–254.
    1. Arterburn DE, Bogart A, Sherwood NE, Sidney S, Coleman KJ, Haneuse S, O’Connor PJ, Theis MK, Campos GM, McCulloch D, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2013;23:93–102.
    1. Fass R, Shapiro M, Dekel R, Sewell J. Systematic review: proton-pump inhibitor failure in gastro-oesophageal reflux disease--where next? Aliment Pharmacol Ther. 2005;22:79–94.
    1. Löfdahl HE, Lane A, Lu Y, Lagergren P, Harvey RF, Blazeby JM, Lagergren J. Increased population prevalence of reflux and obesity in the United Kingdom compared with Sweden: a potential explanation for the difference in incidence of esophageal adenocarcinoma. Eur J Gastroenterol Hepatol. 2011;23:128–132.
    1. Fornari F, Madalosso CA, Farré R, Gurski RR, Thiesen V, Callegari-Jacques SM. The role of gastro-oesophageal pressure gradient and sliding hiatal hernia on pathological gastro-oesophageal reflux in severely obese patients. Eur J Gastroenterol Hepatol. 2010;22:404–411.
    1. Aasheim ET. Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg. 2008;248:714–720.
    1. Salgado W, Modotti C, Nonino CB, Ceneviva R. Anemia and iron deficiency before and after bariatric surgery. Surg Obes Relat Dis. 2014;10:49–54.
    1. Klockhoff H, Näslund I, Jones AW. Faster absorption of ethanol and higher peak concentration in women after gastric bypass surgery. Br J Clin Pharmacol. 2002;54:587–591.
    1. Maluenda F, Csendes A, De Aretxabala X, Poniachik J, Salvo K, Delgado I, Rodriguez P. Alcohol absorption modification after a laparoscopic sleeve gastrectomy due to obesity. Obes Surg. 2010;20:744–748.
    1. Woodard GA, Downey J, Hernandez-Boussard T, Morton JM. Impaired alcohol metabolism after gastric bypass surgery: a case-crossover trial. J Am Coll Surg. 2011;212:209–214.
    1. King WC, Chen JY, Mitchell JE, Kalarchian MA, Steffen KJ, Engel SG, Courcoulas AP, Pories WJ, Yanovski SZ. Prevalence of alcohol use disorders before and after bariatric surgery. JAMA. 2012;307:2516–2525.
    1. Sasse KC, Ganser J, Kozar M, Watson RW, McGinley L, Lim D, Weede M, Smith CJ, Bovee V. Seven cases of gastric perforation in Roux-en-Y gastric bypass patients: what lessons can we learn? Obes Surg. 2008;18:530–534.
    1. Capella JF, Capella RF. Gastro-gastric fistulas and marginal ulcers in gastric bypass procedures for weight reduction. Obes Surg. 1999;9:22–27; discussion 28.
    1. Abd Elrazek AE, Mahfouz HM, Metwally AM, El-Shamy AM. Mortality prediction of nonalcoholic patients presenting with upper gastrointestinal bleeding using data mining. Eur J Gastroenterol Hepatol. 2014;26:187–191.
    1. Abd Elrazek AE, Yoko N, Hiroki M, Afify M, Asar M, Ismael B, Salah M. Endoscopic management of Dieulafoy’s lesion using Isoamyl-2-cyanoacrylate. World J Gastrointest Endosc. 2013;5:417–419.
    1. Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract. 2005;20:517–525.
    1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307:491–497.
    1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303:235–241.
    1. García-García ML, Martín-Lorenzo JG, Campillo-Soto A, Torralba-Martínez JA, Lirón-Ruiz R, Miguel-Perelló J, Mengual-Ballester M, Aguayo-Albasini JL. [Complications and level of satisfaction after dermolipectomy and abdominoplasty post-bariatric surgery] Cir Esp. 2014;92:254–260.
    1. Wyatt SB, Winters KP, Dubbert PM. Overweight and obesity: prevalence, consequences, and causes of a growing public health problem. Am J Med Sci. 2006;331:166–174.
    1. Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, van Balkom AJ, Nolen WA, Zitman FG, Beekman AT, Penninx BW. Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA) J Clin Psychiatry. 2011;72:341–348.
    1. de Graaf R, Bijl RV, Smit F, Vollebergh WA, Spijker J. Risk factors for 12-month comorbidity of mood, anxiety, and substance use disorders: findings from the Netherlands Mental Health Survey and Incidence Study. Am J Psychiatry. 2002;159:620–629.
    1. Cesana G, Uccelli M, Ciccarese F, Carrieri D, Castello G, Olmi S. Laparoscopic re-sleeve gastrectomy as a treatment of weight regain after sleeve gastrectomy. World J Gastrointest Surg. 2014;6:101–106.
    1. Lee WJ, Ser KH, Chong K, Lee YC, Chen SC, Tsou JJ, Chen JC, Chen CM. Laparoscopic sleeve gastrectomy for diabetes treatment in nonmorbidly obese patients: efficacy and change of insulin secretion. Surgery. 2010;147:664–669.
    1. Mechanick JI, Youdim A, Jones DB, Timothy Garvey W, Hurley DL, Molly McMahon M, Heinberg LJ, Kushner R, Adams TD, Shikora S, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & amp; Bariatric Surgery. Surg Obes Relat Dis. 2013;9:159–191.
    1. Adams PL. Long-term patient survival: strategies to improve overall health. Am J Kidney Dis. 2006;47:S65–S85.
    1. Gore JL, Pham PT, Danovitch GM, Wilkinson AH, Rosenthal JT, Lipshutz GS, Singer JS. Obesity and outcome following renal transplantation. Am J Transplant. 2006;6:357–363.
    1. Meier-Kriesche HU, Arndorfer JA, Kaplan B. The impact of body mass index on renal transplant outcomes: a significant independent risk factor for graft failure and patient death. Transplantation. 2002;73:70–74.
    1. Wikiel KJ, McCloskey CA, Ramanathan RC. Bariatric surgery: a safe and effective conduit to cardiac transplantation. Surg Obes Relat Dis. 2014;10:479–484.
    1. DiCecco SR, Francisco-Ziller N. Obesity and organ transplantation: successes, failures, and opportunities. Nutr Clin Pract. 2014;29:171–191.
    1. Elbanna A, Tawella N, Neff K, Abd Elfattah A, Bakr I. Abstracts from the 18th World Congress of the International Federation for the Surgery of Obesity & Metabolic Disorders (IFSO), Istanbul, Turkey 28-31 August 2013. Obes Surg. 2013;23:1017–1243.
    1. Elbanna A, Taweela NH, Gaber MB, Tag El-Din MM, Labib MF, Emam MA, Khalil OO, Abdel Meguid MM, Abd Elrazek MAA. Medical Management of Patients with Modified Intestinal Bypass: A New Promising Procedure for Morbid Obesity. GJMR. 2014;14:8–19.

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