Cirugía bariátrica mediante la técnica del cruce duodenal: evolución ponderal y deficiencias nutricionales asociadas / Bariatric surgery in duodenal switch procedure: weight changes and associated nutritional deficiencies

Introducción La cirugía bariátrica mediante la técnica del cruce duodenal está considerada como uno de los tratamientos más efectivos para conseguir la pérdida de peso y la disminución de comorbilidades en pacientes obesos mórbidos. Derivada de su práctica se pueden producir deficiencias nutricionales que debemos conocer y tratar. Objetivos Valoración de la pérdida de peso y del desarrollo de síndromes carenciales en pacientes obesos mórbidos sometidos a cirugía bariátrica mediante la técnica del cruce duodenal. Material y métodos Se ha estudiado la evolución de 128 pacientes obesos mórbidos sometidos a cirugía bariátrica mediante la técnica del cruce duodenal en el Hospital General Universitario de Albacete. Se realizaron controles ponderales y de las deficiencias nutricionales más relevantes surgidas tras la intervención. Resultados El peso corporal desciende de manera acusada desde un índice de masa corporal (IMC) promedio de 52,9±7,7kg/m2 (40,7-78,5) hasta un IMC de 30,8±5,2kg/m2, con un porcentaje de exceso de peso perdido (%EPP) de 81,4±16,4% a los 18 meses tras la intervención. La pérdida de peso se ralentiza en el seguimiento posterior, llegando a su valor más bajo a los 30 meses postintervención (%EPP del 82,1±16,8; IMC de 30,2±4,3kg/m2) y tiende a estabilizarse en los pacientes con seguimiento más prolongado. Las deficiencias nutricionales más significativas que requirieron tratamiento sustitutivo se detectaron en algunos micronutrientes como el hierro (42,9%), zinc (38,3%) y vitaminas liposolubles A (55,5%) y D (57,8%), entre otros. Conclusiones El tratamiento de la obesidad mórbida mediante cruce duodenal es una técnica muy efectiva para conseguir una importante pérdida de peso de forma mantenida. La elevada presencia de déficits nutricionales durante el seguimiento obliga a realizar revisiones periódicas de forma indefinida (AU)

Introduction: Bariatric surgery using the technique of duodenal switch is considered as one of the most effective treatments to lose weight and decrease comorbidity in morbidly obese patients. However, we have to be familiar with and adequately manage the various nutritional deficiencies that may occur as a consequence of its practice.Objectives: To assess weight loss and development of nutritional deficiencies in morbidly obesepatients undergoing bariatric surgery through the duodenal switch procedure. Material and methods: One hundred and twenty-eight morbidly obese patients underwent aduodenal switch procedure at Hospital General Universitario in Albacete. Weight changes and the most important nutritional deficiencies occurring after surgery were recorded. Results: Median follow-up time was 30 months (interquartile range, 18 months). Body weightmarkedly decreased, with mean body mass index (BMI) decreasing from a preoperative value of 52.9±7.7 kg/m2 to 30.8±5.2 kg/m2 18 months after surgery. The percentage of excess weight lost (% EWL) was 81.4±16.4% in this period. Weight loss slowed down subsequently, reaching its lowest value 30 months after surgery (% EWL 82.1%±16.8, BMI 30.2±4.3 kg/m2) and tended tostabilize in patients with longer follow-up times. Significant nutritional deficiencies requiring replacement therapy were detected in some micronutrients with iron (42.9%), zinc (38.3%),vitamin A (55.5%), and vitamin D (57.8%) deficiencies being most relevant.Conclusions: Duodenal switch is a very effective surgical procedure for treating morbidly obesepatients because it allows for achieving a significant and sustained weight loss.Close lifetimemonitoring is required in these patients because of the high prevalence of nutritional deficiencies during follow-up (AU)

[Bariatric surgery in duodenal switch procedure: weight changes and associated nutritional deficiencies]. / Cirugía bariátrica mediante la técnica del cruce duodenal: evolución ponderal y deficiencias nutricionales asociadas.

INTRODUCTION: Bariatric surgery using the technique of duodenal switch is considered as one of the most effective treatments to lose weight and decrease comorbidity in morbidly obese patients. However, we have to be familiar with and adequately manage the various nutritional deficiencies that may occur as a consequence of its practice. OBJECTIVES: To assess weight loss and development of nutritional deficiencies in morbidly obese patients undergoing bariatric surgery through the duodenal switch procedure. MATERIAL AND METHODS: One hundred and twenty-eight morbidly obese patients underwent a duodenal switch procedure at Hospital General Universitario in Albacete. Weight changes and the most important nutritional deficiencies occurring after surgery were recorded. RESULTS: Median follow-up time was 30 months (interquartile range, 18 months). Body weight markedly decreased, with mean body mass index (BMI) decreasing from a preoperative value of 52.9±7.7kg/m(2) to 30.8±5.2kg/m(2) 18 months after surgery. The percentage of excess weight lost (% EWL) was 81.4±16.4% in this period. Weight loss slowed down subsequently, reaching its lowest value 30 months after surgery (% EWL 82.1%±16.8, BMI 30.2±4.3kg/m(2)) and tended to stabilize in patients with longer follow-up times. Significant nutritional deficiencies requiring replacement therapy were detected in some micronutrients with iron (42.9%), zinc (38.3%), vitamin A (55.5%), and vitamin D (57.8%) deficiencies being most relevant. CONCLUSIONS: Duodenal switch is a very effective surgical procedure for treating morbidly obese patients because it allows for achieving a significant and sustained weight loss.Close lifetime monitoring is required in these patients because of the high prevalence of nutritional deficiencies during follow-up.