Nutrient Deficiencies After Laparoscopic Roux-en-y Gastric Bypass and Laparoscopic Sleeve Gastrectomy: A Comparative Study

Pakkavuth Chanswangphuvana, MD, Narong Boonyagard, MD, Pondech Vichajarn, MD, Ajjana Techagumpuch, MD, Suppa-ut Pungpapong, MD, Krit Kitisin, MD, Chadin Tharavej, MD, Patpong Navicharern, MD, Suthep Udomsawaengsup, MD. MIS Unit, Department of Surgery, Faculty of Medicine, Chulalongkorn University, BKK, THAILAND

Introduction: Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) was the preferred bariatric procedure in terms of weight loss and remission of co-morbidities, however nutrient deficiencies were common. Laparoscopic Sleeve Gastrectomy (LSG) was increasing in popularity with remarkable effectiveness and less nutrient deficiencies.

Objective: We determine the amount of pre-operative nutrient deficiencies in morbidly obese patients and compare nutritional status during the first post-operative year between LRYGB and LSG.

Methods: One hundred and seventy-seven patients underwent Bariatric procedures between January 2011 and December 2013 were assigned to a standardized follow-up program. Data of interest were pre-operative nutrient status, percent of excess weight loss (%EWL) at 1 year and nutrient deficiencies during the first post-operative year. Deficiencies were supplemented when found and excluded from the analysis.

Results: One hundred and fifty morbidly obese patients with completion of blood withdrawal pre-operatively and during the first post-operative year were included in the study (64 LRYGB and 78 LSG). Pre-operative nutrient deficiencies were found in 29 patients including 2 iron deficiency and 28 vitamin D deficiency. Post-operative nutrient deficiencies had no significant difference between both groups (45.1% in LRYGB vs 39.1%, p=0.629) with significantly higher %EWL at 1 year in LRYGB (71.9% in LRYGB vs 53.1%, p<0.001). Subgroup analysis of iron, folate, vitamin B12 and vitamin D deficiencies showed no significant difference between both groups, however %EWL at 1 year were also significantly higher in LRYGB (p<0.001).

Conclusion: Nutrient deficiencies in morbidly obese patients are common in Thai Population that should be concerned and supplemented before undergoing bariatric procedures. Nutrient deficiencies after Laparoscopic Roux-en-Y Gastric bypass occur frequently but are comparable with those of Laparoscopic Sleeve Gastrectomy, however significant weight loss at 1-year follow-up is preferable in Laparoscopic Roux-en-Y Gastric Bypass.

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