With a noted increase in the population with morbid obesity, surgical treatment is increasing significantly to address this serious national health problem.  Surgical treatment falls into two categories: A restrictive procedure e.g. Gastric Banding and a restrictive plus a mal-absorptive operation such as Roux-en-Y Gastric Bypass or RYGB which accounts for  80%  of obesity operations performed in the United States. The result allows the patient to feel “full” sooner by eating less due to the reduction in stomach size, and also it allows less fat absorption due to the bypassed areas of the stomach and duodenum. This procedure has had great success even with long term follow up as long as the patient is dedicated to post-operative instructions and care. Regardless, there are some significant complications that may occur both peri-operatively and post-operatively.

Complications that may develop can be roughly categorized into four major areas that include infectious complications, hematologic complications, mechanical complications and nutritional deficiencies. Three of these categories are significantly impacted by the quality of the patients’ nutrition, including key vitamins and minerals. Infectious problems that may arise include skin incisional infections and incisional leaks leading to peritonitis. The latter is where gastric/intestinal contents leak into the abdomen.

As with any infection, the immune system is critical to a good outcome and also important during post-operative stress recovery on many bodily systems. All of the key anti-oxidant vitamins are beneficial in this regard. Specifically wound healing is facilitated by Vitamin A which has been shown to actually protect against intra-abdominal infections after surgery. It also has been identified to help increase the strength of wound scaring and healing. Vitamin C promotes collagen formation as well as elastin, both of which are involved in wound healing, as does thiamine. Vitamin B5, in combination with Vitamin C, speeds incisional recovery as well. Zinc also has been shown to benefit wound healing. Pre-operative nutrition that focuses on these micro-nutrients can reduce the chances of these complications, especially Vitamin C and B complex vitamins which are generally poorly stored by the body.

 Hematologic complications mainly involve the occurrence of anemia. After gastric bypass surgery, absorption of iron and Vitamin B12 may be significantly reduced. Vitamin B12 requires a co-factor that is normally  in the stomach wall that allows it to be absorbed into the body. Many patients therefore can lose the ability to absorb B12, and must receive injections weekly or monthly to supplement their bodies. Vitamin B12 is a key vitamin in the formation of red blood cells, as well as in the function of nervous system tissues.

Iron also is an important trace mineral required by the red blood cells to help carry oxygen. Its deficiency due to poor absorption as well can lead to anemia. While anemia is a condition in and of itself that causing fatigue and weakness, its presence in a post-operative patient can further cause poor wound healing and recovery. The other major hematologic complication is a blood clot that travels to the lung, or a pulmonary embolism. This is a result of immobility of a patient after surgery which is further complicated by obesity. Mobility and mechanical treatments are consistently employed to reduce this risk. There is some research evidence that Vitamins C and E promote better pulmonary function post-operatively.

Osteoporosis is the third category that has major nutritional components. This complication develops due to the lack of adequate major minerals in the body, specifically calcium, phosphorous and magnesium. All of these minerals are essential for good bone formation, as well as other functions such as muscular functions, nervous system function, and enzyme facilitation throughout the body, among others. Without these present, bones become weaker and porous, resulting in osteoporosis. Supplementation may be needed for these minerals to prevent this from developing, and their amounts can be sampled through routine blood analysis. Vitamin D is also critical for bone formation, but generally is less common to be deficient as routine sun exposure allows our skin cells to make this needed vitamin even when dietary presence is lacking.

 Mechanical problems that may arise post-operatively include a narrowing of the passage from the stomach to the intestine due to post operative strictures, this can result in nausea and vomiting. The portion of the stomach bypassed can also enlarge which could lead to bloating and hiccoughs. Hernias through the incision are a less common problem. The most common complication in this category is what is called “dumping syndrome”. Because of the shortened portion of intestine, absorption time is less and this can result in too rapid a transit of food materials through the bowel. Because it is too accelerated, this also can affect the ability to absorb vitamins and minerals resulting in further complications listed above, among others that are less common. Dietary manipulation in portion size, meal timing, food content especially with sweets, and less commonly medications can be used to alleviate this problem.

While these post-operative problems seem numerous, less than 10% have minor complications after surgery, and approximately 5% have serious problems. Attention to nutritional issues both prior to surgery and afterwards can significantly reduce the risk of these conditions. Regardless, the benefits to one’s overall health from weight reduction are substantial and far outweigh these concerns. Patients after RYGB or GB operation need to consult with their physician regarding all dietary intakes and vitamin supplementations.