Quadriparesis After Bariatric Surgery: Case Report

Mini-invasive Surgery , 2020

Bariatric surgeries have proven to be an effective treatment for morbid obesity to reduce the excess body weight of the individuals. Besides weight loss and improvement in metabolic parameters, bariatric surgery procedures can also cause some complications. One of the most common complications observed after bariatric surgery is vitamin deficiencies. Vitamin deficiencies occur due to malabsorptive surgery in patients with absorption disorder and restrictive surgery in patients with inadequate intake. These deficiencies may be accompanied by systematic and neurological findings. Therefore, regular follow-up of patients after bariatric surgery is crucial. If any vitamin deficiency is detected in the patient clinically or biochemically, it is recommended to eliminate this deficiency through supplementation.

The Turkish Journal of Endocrinology and Metabolism, 2021

Obesity Surgery, 2007

Lifestyle intervention programmes often produce insufficient weight loss and poor weight loss maintenance. As a result, an increasing number of patients with obesity and related comorbidities undergo bariatric surgery, which includes approaches such as the adjustable gastric band or the 'divided' Roux-en-Y gastric bypass (RYGB). This Review summarizes the current knowledge on nutrient deficiencies that can develop after bariatric surgery and highlights follow-up and treatment options for bariatric surgery patients who develop a micronutrient deficiency. The major macronutrient deficiency after bariatric surgery is protein malnutrition. Deficiencies in micronutrients, which include trace elements, essential minerals, and watersoluble and fat-soluble vitamins, are common before bariatric surgery and often persist postoperatively, despite universal recommendations on multivitamin and mineral supplements. Other disorders, including small intestinal bacterial overgrowth, can promote micronutrient deficiencies, especially in patients with diabetes mellitus. Recognition of the clinical presentations of micronutrient deficiencies is important, both to enable early intervention and to minimize long-term adverse effects. A major clinical concern is the relationship between vitamin D deficiency and the development of metabolic bone diseases, such as osteoporosis or osteomalacia; metabolic bone diseases may explain the increased risk of hip fracture in patients after RYGB. Further studies are required to determine the optimal levels of nutrient supplementation and whether postoperative laboratory monitoring effectively detects nutrient deficiencies. In the absence of such data, clinicians should inquire about and treat symptoms that suggest nutrient deficiencies.

Obesity Surgery, 2010

Background Surgical treatment has proved to be effective for weight loss, improving the quality of life of obese individuals. However, metabolic and nutritional deficiencies may occur during the late postoperative period. The objective of the present study was to assess the metabolic and nutritional profile of grade III obese individuals for 12 months after Roux-en-Y gastric bypass (RYGBP). Methods Forty-eight patients with mean body mass index (BMI) of 51.9±7.8 kg/m 2 were submitted to RYGBP. Anthropometric, food intake, and biochemical data were obtained before and for 12 months after surgery. Results There was an average weight and body fat reduction of 35% and 46%, respectively. Calorie intake was reduced, ranging from 773±206 to 1035±345 kcal during the study. Protein intake remained below recommended values throughout follow-up, corresponding to 0.5±0.3 g/kg/ current body weight/day during the 12th month. Iron and fiber intake was significantly reduced, remaining below recommended levels throughout the study. Serum cholesterol, low-density lipoprotein cholesterol, and glycemia were reduced. Albumin deficiency was present in 15.6% of subjects at the beginning of the study vs 8.9% at the end, calcium deficiency was present in 3.4% vs 16.7%, and iron deficiency was present in 12.2% vs 14.6%.

The Lancet Gastroenterology & Hepatology, 2021

We identified references through searches of PubMed, MEDLINE and Embase using the following terms ("nutritional OR malnutrition OR deficiency OR neuropathy OR anemia OR hypoglycemia OR bone OR oxalate OR liver OR complications") AND ("bariatric surgery") from the opening date of the databases to 1st March 2020. Articles were also identified through searches in the authors' files. Only papers published in English were included. We selected and reviewed the articles describing long-term nutritional and metabolic complications after bariatric surgery. The final reference list was generated based on the novelty and relevance to the broad scope of this review.

Obesity Surgery - OBES SURG, 2010

Background To assess the prevalence of nutritional deficiencies amongst people who suffer from morbid obesity and are candidates for bariatric surgery and to evaluate the relations between pre-operative nutritional deficiencies and demographic data and co-morbidities. Methods Preoperative blood tests of 114 patients (83 women and 31 men) were collected. The blood tests included plasma chemistry (including albumin, total protein, iron, ferritin, vitamin B12, folic acid, parathyroid hormone (PTH), calcium, and phosphorous) and a blood count (for hemoglobin and mean corpuscular volume (MCV)). Demographic and socio-economic details were collected from all patients. Results Mean age, weight, and BMI of the patients were 38 years (15–77), 122.9 kg (87–250), and 44.3 kg/m2 (35.3–74.9), respectively. The prevalence of pre-operative nutritional deficiencies were: 35% for iron, 24% for folic acid, 24% for ferritin, 3.6% for vitamin B12, 2% for phosphorous, and 0.9% for calcium, Hb and MCV ...

Background Two main causes for nutrient deficiencies following bariatric surgery (BS) are pre-operative deficiencies and favoring foods with high-energy density and poor micro-nutrient content. The aims of this study were to evaluate nutritional status and gender differences and the prevalence of nutritional deficiencies among candidates for laparoscopic sleeve gastrectomy (LSG) surgery. Methods A cross-sectional analysis of pre-surgery data collected as part of a randomized clinical trial on 100 morbidly obese patients with non-alcoholic fatty liver disease (NAFLD) admitted to LSG surgery at Assuta Medical Center between February 2014 and January 2015. Anthropometrics, food intake , and fasting blood tests were evaluated during the base-line visit. Results One-hundred patients completed the pre-operative measurements (60 % female) with a mean age of 41.9 ± 9.8 years and a mean BMI of 42.3 ± 4.7 kg/m 2. Pre-operatively , deficiencies for iron, ferritin, folic acid, vitamin B1, vitamin B12, vitamin D, and hemoglobin were 6, 1, 1, 6, 0, 22, and 6 %, respectively. Pre-surgery, mean energy, protein, fat, and carbohydrate intake were 2710.7 ± 1275.7 kcal/day, 114.2 ± 48.5, 110.6 ± 54.5, and 321.6 ± 176.1 gr/day, respectively. The intakes for iron, calcium, folic acid, vitamin B12, and vitamin B1 were below the Dietary Reference Intake (DRI) recommendations for 46, 48, 58, 14, and 34 % of the study population, respectively. Conclusion We found a low prevalence of nutritional deficiencies pre-operatively except for vitamin D. Most micronu-trient intake did not reach the DRI recommendations, despite

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2016

Background: Laparoscopic sleeve gastrectomy (LSG) is being increasingly established as a definitive procedure for weight loss. The mechanism for weight loss in LSG is gastric restriction and neurohormonal changes, but there is deficient information on its nutritional effect. The aim of this prospective study was to assess vitamin and micronutrient deficiencies following LSG (whats and when) in organized follow-up visits. Patients and Methods: LSG was performed in 112 consecutive patients between June 2010 and December 2013. In all patients, the vitamin and micronutrient deficiencies were corrected before the LSG procedure. Patients were investigated for vitamin and micronutrient concentrations 2, 4, 6, 9, and 12 months after surgery. Results: During the study time, 112 patients (65% female) underwent LSG. The mean age was 26 years (range: 20 to 37 y), and the mean preoperative body mass index was 41 (range: 35 to 52). Complications and nutrient deficiencies were observed and analyzed throughout the follow-up period. Conclusions: The appearance of vitamin and nutritional deficiencies after LSG is a common phenomenon. Correction of the deficiencies before surgery, sufficient supplementation immediately after the procedure, and routine long follow-up are important to avoid the serious consequences of the deficiencies.

International Journal of Environmental Research and Public Health

The obesity epidemic, mainly due to lifestyle changes in recent decades, leads to serious comorbidities that reduce life expectancy. This situation is affecting the health policies of many nations around the world. Traditional measures such as diet, physical activity, and drugs are often not enough to achieve weight loss goals and to maintain the results over time. Bariatric surgery (BS) includes various techniques, which favor rapid and sustained weight loss. BS is a useful and, in most cases, the best treatment in severe and complicated obesity. In addition, it has a greater benefit/risk ratio than non-surgical traditional therapies. BS can allow the obese patient to lose weight quickly compared with traditional lifestyle changes, and with a greater probability of maintaining the results. Moreover, BS promotes improvements in metabolic parameters, even diabetes remission, and in the quality of life. These changes can lead to an increase of life expectancy by over 6 years on averag...

The ERROS Connectionist Database , 2019

The innovative, patented, NoSQL ERROS Connectionist Database provides an incremental way of creating powerful business applications without detailed upfront user or system specifications, without physical file design and mostly without any program coding or program generation. Database and application structures are defined in the user's natural language rather than in program code. Security can be at the field level. No new files are created during application creation and there are no compiled ERROS applications. The ERROS database handler interprets the definitions and accesses and updates all metadata and all user data for all ERROS applications. Records can be of infinitely variable length, without null values, and attributes are repeating by default. The database can combine very complex multidimensional, relational and network data structures with limitless nested levels of hierarchy, without redundancy. Application development is largely self-documenting and changes can be rolled back. The almost zero second response times do not noticeably change as file sizes grow. The ERROS Connectionist Database is automatically indexed with a unique multipart key structure. There can be limitless bidirectional connections between any records of any type. ERROS turns raw data into a fully navigable semantic network. Users can browse the bidirectional connections in either direction, with the same immediate response, without using joins and without using a query language. Data can also be stored about any connection or relationship as can lower level nested connections. ERROS generates HTML and Javascript on the fly and can be used for creating major, web enabled applications, with automatic concurrency control, and including transaction processing, for a wide variety of businesses, and for the humanities. The ERROS Connectionist Database Since the beginning of the computer industry, business applications have been built using computer programs. These contain the business rules and a database stores the data to which these rules apply. These separate worlds of data and programs have to be kept in synchronisation, at best a fragile process as it requires two different disciplines-program coding and database design. This separatism-the splitting of the data from the rules-is responsible for most of the unnecessary complexity, high costs and extended time scales of application development and maintenance. Making even simple changes to a traditional, separatist system can be a problem. Adding an extra field to an existing table may seem straight forward, yet implementing such a change can be quite challenging. This is because of the architecture of traditional applications, which, with their rigid database systems and computer programs, are not easy to change. Application creation has always depended on computer programs, created by programmers or generated by a computer. Program coding is a very slow process and as program languages are not understood by users, they cannot be sure that a system will meet their needs until it is ready for final testing. They might request changes that they consider minor but which are not easy to implement.