Fatima Cody Stanford, MD, a specialist in obesity medicine, took the stage multiple times at Pri-Med Southwest 2022 to educate conference attendees on issues related to her area of expertise. A physician and scientist with Massachusetts General Hospital, Boston, and Harvard Medical School, Dr. Stanford, focused on bariatric surgery in a presentation offered as part of a “Curbside Consult” portion of the conference.
What are the primary complications associated with metabolic and bariatric surgery?
Dr. Stanford focused on the two bariatric procedures most commonly executed in the U.S.— the Roux-en-Y Gastric Bypass and the Gastric Sleeve. The most common complications for the first procedure include sustained tachycardia, bilious vomiting, and abdominal pain with vomiting. Later occurring signs or symptoms of complications include colicky abdominal pain after meals, excessive weight loss, profound weight loss with vomiting, and weight gain.
Complications of Gastric Sleeve surgery include hemorrhage, leaking, abscess, stricture, nutrient deficiency, and GERD, according to Dr. Stanford.
Which vitamins are required for post-op patients and how do you recognize deficiencies?
The vitamin deficiencies most commonly seen in patients who have undergone these surgeries are vitamin B12, Vitamin D, calcium, and iron. Patients are least likely to experience deficiencies in copper, thiamin, or zinc.
Dr. Stanford stressed that patients require life-long vitamin supplementation following their surgery. Supplementation should take the form of a multivitamin, calcium citrate plus Vitamin D, Vitamin D alone, and Vitamin B12.
How do you manage the patient who has inadequate weight loss or regains weight?
Unfortunately, patients who undergo bariatric surgery may see inadequate weight loss (<20% of total body weight loss) or may regain lost weight. Current data suggest that 25-35% of individuals who undergo bariatric surgery will have significant weight gain within 2-5 years. As a result, clinicians might reasonably turn to pharmacotherapy as an adjunct to surgery. Drugs FDA approved for such use include CNS stimulants/anorexiants, anti-depressants/dopamine reuptake inhibitors/opioid antagonists, and gastrointestinal agents. Other agents to consider, although they are not FDA-approved to support weight loss, include topiramate, zonisamide, bupropion, metformin, the amylin agonist pramlintide, and the SGLT2 inhibitors canagliflozin and dapagliflozin.