Peri- and post-operative management in bariatric surgery

Abstract

Owing to the worldwide obesity epidemic there is an increased demand for bariatric surgery, which has proven effective in reducing obesity-related morbidity and mortality. As a prerequisite for successful treatment, careful pre-operative evaluation and life-long post-operative care within an interdisciplinary setting is mandatory. The scope of this review is to summarize current knowledge on peri-operative complications, post-operative nutritional deficiencies and treatment options after bariatric surgery. Among the most common complications related to surgery are vomiting and bleeding, as well as chronic nutritional deficiency. The major macronutrient deficiency is protein malnutrition leading to oedema and other related consequences. Micronutrients, which comprise water- and fat-soluble vitamins, essential minerals and trace elements, need to be substituted in most patients. Many patients already suffer from nutritional deficiencies prior to bariatric surgery, which, if not corrected, can cause the patient to deteriorate. Recognition of nutritional deficiencies is important to avoid short- and long-term adverse effects. Depending on the bariatric procedure, the requirement of supplementation and the follow-up schedule might be different. In this regard, studies on optimizing post-operative supplementation strategies, as well as those on avoiding chronic complications, are greatly encouraged.