Skip to main content

Advertisement

SpringerLink
Log in

Evolution of Hematological Parameters During the First 2 Years After Laparoscopic Sleeve Gastrectomy: Results of a Retrospective Study

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Purpose

Laparoscopic sleeve gastrectomy (LSG) is one of the most effective bariatric surgery methods of treatment for obesity. It can cause nutritional deficiencies and lead to anemia at the same time. The aim of the present study is to retrospectively investigate whether the supplement treatment administration to cases that underwent LSG is sufficient in terms of the hematological parameters.

Material and Methods

A total of 494 obese patients between 18 and 65 years who underwent LSG were recruited to the study. Vitamin B12, iron, and folic acid replacement therapy are prescribed to all patients who can be followed-up at regular intervals. We compared hemogram, iron studies, vitamin B12, and folic acid values of these patients at preoperative and at first visit (1 month), 3, 6, 12, and 24 months post-surgery.

Results

The number of patients with anemia and vitamin B12 and folic acid deficiencies decreased significantly during the follow-up with supplementation. Postoperative leucocyte and thrombocyte levels were significantly lower than the preoperative levels.

Conclusion

Our study indicates that the proper supplementation therapy in patients attending regular follow-up helps to keep hematological parameters within the normal range and to improve anemia and deficiencies of vitamin B12 and folic acid. Compliance with follow-up programs is essential after costly and invasive treatments such as sleeve gastrectomy to improve the well-being of patients in the long-term and to maximize compliance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023.

    Article  Google Scholar 

  2. Castro AV, Kolka CM, Kim SP, et al. Obesity, insulin resistance and comorbidities? Mechanisms of association. Arq Bras Endocrinol Metabol. 2014;58(6):600–9.

    Article  Google Scholar 

  3. Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374(2):113–23.

    Article  CAS  Google Scholar 

  4. Deveney CW, Martindale RG. Factors in selecting the optimal bariatric procedure for a specific patient and parameters by which to measure appropriate response to surgery. Curr Gastroenterol Rep. 2010;12(4):296–303.

    Article  Google Scholar 

  5. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20(6):859–63.

    Article  CAS  Google Scholar 

  6. Sanchez-Santos R, Masdevall C, Baltasar A, et al. Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish National Registry. Obes Surg. 2009;19(9):1203–10.

    Article  Google Scholar 

  7. Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26(11–12):1031–7.

    Article  CAS  Google Scholar 

  8. von Drygalski A, Andris DA. Anemia after bariatric surgery: more than just iron deficiency. Nutr Clin Pract. 2009;24(2):217–26.

    Article  Google Scholar 

  9. Bordalo LA, Teixeira TF, Bressan J, et al. Bariatric surgery: how and why to supplement. Rev Assoc Med Bras (1992). 2011;57(1):113–20.

    Article  Google Scholar 

  10. Arslan P, Dağ A, Türkmen E. Her yönüyle obezite; önleme ve tedavi yöntemleri. İstanbul: Ofset Matbacılık; 2012.

    Google Scholar 

  11. Ritz P, Becouarn G, Douay O, et al. Gastric bypass is not associated with protein malnutrition in morbidly obese patients. Obes Surg. 2009;19(7):840–4.

    Article  Google Scholar 

  12. Coupaye M, Puchaux K, Bogard C, et al. Nutritional consequences of adjustable gastric banding and gastric bypass: a 1-year prospective study. Obes Surg. 2009;19(1):56–65.

    Article  Google Scholar 

  13. Nogueira I, Hrovat K. Adolescent bariatric surgery: review on nutrition considerations. Nutr Clin Pract. 2014;29(6):740–6.

    Article  Google Scholar 

  14. de Benoist B. Conclusions of a WHO technical consultation on folate and vitamin B12 deficiencies. Food Nutr Bull. 2008;29(2 Suppl):S238–44.

    Article  Google Scholar 

  15. Treadwell JR, Sun F, Schoelles K. Systematic review and meta-analysis of bariatric surgery for pediatric obesity. Ann Surg. 2008;248(5):763–76.

    Article  Google Scholar 

  16. Saif T, Strain GW, Dakin G, et al. Evaluation of nutrient status after laparoscopic sleeve gastrectomy 1, 3, and 5 years after surgery. Surg Obes Relat Dis. 2012;8(5):542–7.

    Article  Google Scholar 

  17. Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.

    Article  Google Scholar 

  18. Shah M, Simha V, Garg A. Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab. 2006;91(11):4223–31.

    Article  CAS  Google Scholar 

  19. Goldberg HR, Chin VL, Zitsman JL, et al. Bariatric surgery in adolescents: is routine nutrient supplementation sufficient to avoid anemia following bariatric surgery? Nutr Clin Pract. 2017;32(4):502–7.

    Article  Google Scholar 

  20. Capoccia D, Coccia F, Paradiso F, et al. Laparoscopic gastric sleeve and micronutrients supplementation: our experience. J Obes. 2012;2012:672162.

    Article  CAS  Google Scholar 

  21. Kwon Y, Kim HJ, Lo Menzo E, et al. Anemia, iron and vitamin B12 deficiencies after sleeve gastrectomy compared to Roux-en-Y gastric bypass: a meta-analysis. Surg Obes Relat Dis. 2014;10(4):589–97.

    Article  Google Scholar 

  22. Alvarez-Leite JI. Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care. 2004;7(5):569–75.

    Article  Google Scholar 

  23. Bloomberg RD, Fleishman A, Nalle JE, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15(2):145–54.

    Article  Google Scholar 

  24. Gudzune KA, Huizinga MM, Chang HY, et al. Screening and diagnosis of micronutrient deficiencies before and after bariatric surgery. Obes Surg. 2013;23(10):1581–9.

    Article  Google Scholar 

  25. Hakeam HA, O’Regan PJ, Salem AM, et al. Impact of laparoscopic sleeve gastrectomy on iron indices: 1 year follow-up. Obes Surg. 2009;19(11):1491–6.

    Article  Google Scholar 

  26. Mallory GN, Macgregor AM. Folate status following gastric bypass surgery (the great folate mystery). Obes Surg. 1991;1(1):69–72.

    Article  CAS  Google Scholar 

  27. Jauregui-Lobera I. Iron deficiency and bariatric surgery. Nutrients. 2013;5(5):1595–608.

    Article  CAS  Google Scholar 

  28. Steenackers N, Van der Schueren B, Mertens A, et al. Iron deficiency after bariatric surgery: what is the real problem? Proc Nutr Soc. 2018;77(4):445–55.

    Article  Google Scholar 

  29. Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25(11–12):1150–6.

    Article  CAS  Google Scholar 

  30. Albanopoulos K, Alevizos L, Natoudi M, et al. C-reactive protein, white blood cells, and neutrophils as early predictors of postoperative complications in patients undergoing laparoscopic sleeve gastrectomy. Surg Endosc. 2013;27(3):864–71.

    Article  Google Scholar 

  31. Chen SB, Lee YC, Ser KH, et al. Serum C-reactive protein and white blood cell count in morbidly obese surgical patients. Obes Surg. 2009;19(4):461–6.

    Article  Google Scholar 

  32. Herishanu Y, Rogowski O, Polliack A, et al. Leukocytosis in obese individuals: possible link in patients with unexplained persistent neutrophilia. Eur J Haematol. 2006;76(6):516–20.

    Article  Google Scholar 

  33. Federico A, D'Aiuto E, Borriello F, et al. Fat: a matter of disturbance for the immune system. World J Gastroenterol. 2010;16(38):4762–72.

    Article  CAS  Google Scholar 

  34. Livingston EH. Bariatric surgery in the new millennium. Arch Surg. 2007;142(10):919–22.

    Article  Google Scholar 

  35. Green R. Anemias beyond B12 and iron deficiency: the buzz about other B's, elementary, and nonelementary problems. Hematol Am Soc Hematol Educ Prog. 2012;2012:492–8.

    Article  Google Scholar 

  36. Xanthakos SA. Nutritional deficiencies in obesity and after bariatric surgery. Pediatr Clin N Am. 2009;56(5):1105–21.

    Article  Google Scholar 

Download references

Acknowledgments

The final outcome of this project required a lot of guidance and assistance from many people. We thank the Bezmialem University especially the Department of Internal Medicine and General Surgery to have got this all along the completion of our study.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Bezmialem Vakıf University Faculty of Medicine, Adnan Menderes Blv., Vatan Cad., 34093, Istanbul, Turkey

    Nang Hseng Kyio

  2. Department of Endocrinology and Metabolism, University of Health Science Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey

    Seda Turgut

  3. Department of Hematology, Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey

    Tuba Ozkan

  4. Department of Hematology, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey

    Guven Cetin

Authors
  1. Nang Hseng Kyio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seda Turgut
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tuba Ozkan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guven Cetin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nang Hseng Kyio.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Does not apply. For this type of study, formal consent is not required.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kyio, N.H., Turgut, S., Ozkan, T. et al. Evolution of Hematological Parameters During the First 2 Years After Laparoscopic Sleeve Gastrectomy: Results of a Retrospective Study. OBES SURG 30, 2606–2611 (2020). https://doi.org/10.1007/s11695-020-04528-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-020-04528-x

Keywords

Search

Navigation