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Effects of Laparoscopic Sleeve Gastrectomy on Parathyroid Hormone, Vitamin D, Calcium, Phosphorus, and Albumin Levels

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Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) reduces obesity-related co-morbidities, such as diabetes, hypertension, and hyperlipidemia. Endocrinological abnormalities may occur as undesired side effects. Most centers routinely prescribe folic acid, cyanocobalamin (vitB12), and protein replacement in the postoperative period, but 25-OH-vitamin-D3 (vitD) and intact parathyroid hormone (iPTH) levels are not routinely followed up. The aim of this study was to identify the effects of LSG on iPTH, vitD, calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and albumin levels.

Methods

Data of morbidly obese patients who underwent LSG between January and December 2014 were studied in this prospectively designed study. Serum levels of iPTH, vitD, Ca, P, folic acid, vitB12, ALP, and albumin were measured preoperatively and postoperatively at the 3rd, 6th, and 12th months.

Results

In total, 119 patients were analyzed. All patients had normal iPTH, vitD, Ca, P, folic acid, vitB12, ALP, and albumin values preoperatively, and 31.6% had received vitD supplementation during their nutritionist observation time before surgery. At the 3rd, 6th, and 12th postoperative months, 21 (17.6%), 17 (17.3%), and 1 (0.8%) patients, respectively, had increased iPTH and ALP and decreased vitD levels. A total of 39 (32.7%) patients needed high-dose vitD treatment during a 1 year follow-up. Approximately 37.5% of the patients who received vitD supplementation preoperatively needed vitD supplementation postoperatively. Hospital records of 101 of 119 patients who underwent LSG could be screened to determine their vitD supplementation requirements previously ordered by their nutritionist for a 1-year period before LSG. Thirty-two (31.6%) of the 101 patients had received vitD supplementation during the 1-year period preoperatively.

Conclusions

Although serum levels of iPTH, vitD, Ca, P, vitB12, ALP, and albumin may be normal preoperatively, severe vitD insufficiency requiring high-dose vitD replacement may develop in morbidly obese patients postoperatively. Instead of iPTH and vitD, which are expensive to measure, ALP serum level, which is correlated with iPTH levels, can be a good indicator to monitor calcium metabolism.

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Authors and Affiliations

  1. General Surgery Clinic, Sisli Hamidiye Etfal Education and Research Hospital, Halaskargazi Cad. Etfal Sok., 34733, Sisli, Istanbul, Turkey

    Mehmet Mihmanli, Riza Gurhan Isil & Sinan Omeroglu

  2. Anesthesiology Clinic, Sisli Hamidiye Etfal Education and Research Hospital, Halaskargazi Cad. Etfal Sok., 34733, Sisli, Istanbul, Turkey

    Canan Tulay Isil, Pinar Sayin & Sibel Oba

  3. Endocrinology Clinic, Sisli Hamidiye Etfal Education and Research Hospital, Halaskargazi Cad. Etfal Sok., 34733, Sisli, Istanbul, Turkey

    Feyza Yener Ozturk & Yuksel Altuntas

Authors
  1. Mehmet Mihmanli
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  2. Riza Gurhan Isil
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  3. Canan Tulay Isil
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  4. Sinan Omeroglu
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  5. Pinar Sayin
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  6. Sibel Oba
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  7. Feyza Yener Ozturk
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  8. Yuksel Altuntas
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Contributions

Mehmet Mihmanli was the primary surgeon and designed the study. Rıza Gurhan Isil assisted through the surgical process, collected data and wrote the manuscript. Canan Tulay Isil helped collecting data and writing the manuscript. Sinan Omeroglu helped surgery and collected data. Pinar Sayin and Sibel Oba collected data and gave anesthesia perioperatively. Feyza Yener Ozturk did the statistical analysis and was the responsible endocrinologist. Yuksel Altuntas reviewed the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Riza Gurhan Isil.

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Conflict of Interest

Mehmet MIHMANLI, Riza Gurhan ISIL, Canan Tulay ISIL, Sinan OMEROGLU, Pinar SAYIN, Sibel OBA, Feyza Yener OZTURK, and Yuksel ALTUNTAS declare that they have no conflict of interests in the preparation of this manuscript.

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

Informed consent was obtained from all individual participants included in this study.

Financial Support

It was provided by departmental sources.

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Mihmanli, M., Isil, R.G., Isil, C.T. et al. Effects of Laparoscopic Sleeve Gastrectomy on Parathyroid Hormone, Vitamin D, Calcium, Phosphorus, and Albumin Levels. OBES SURG 27, 3149–3155 (2017). https://doi.org/10.1007/s11695-017-2747-x

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  • DOI: https://doi.org/10.1007/s11695-017-2747-x

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