[Effectiveness and complications of bariatric surgery in the treatment of morbid obesity].

OBJECTIVE

Bariatric surgery represents an affective therapeutic alternative for patients with morbid obesity refractory to medical treatment. However, these surgical techniques increase the risk of producing a protein-energy hyponutrition or a selective deficit of some micronutrient. The aim of this work has been to analyze the anthropometrical, nutritional, digestive and cardiovascular risk factors changes and quality of life in patients with morbid obesity submitted to bariatric surgery.

METHODS

Retrospective descriptive study evaluating a group of patients with morbid obesity submitted to bariatric surgery (45 by means of biliopancreatic bypass according to Scopirano's procedure, and 25 by laparoscopic gastric bypass). Anthropometrics (height, weight, body mass index), cardiovascular risk factors (arterial blood pressure, lipid and glycemic profiles, serum uric acid) and nutritional parameters (serum albumin, complete blood count, and phosphorus and calcium) were assessed before the bariatric procedure and one and two years after surgical treatment. Quality of life was evaluated through the B.A.R.O.S. system.

RESULTS

Seventy patients with morbid obesity have been analyzed (56 women and 14 men) with a mean age of 36.5 +/- 11 years. Mean pre-surgical weight was 129.7 +/- 25.6 kg and BMI 48.8 +/- 8.8 kg/m2. Two years after the surgical procedure BMI was 31.0 +/- 6.6 kg/m2, the ponderal reduction 47.7 kg and the percentage of weight loss 36.5%. Hundred percent of dislipidemic patients, 90% of diabetic patients, and 72% of hypertensive patients normalized their corresponding profiles after surgery. The most common nutritional complications were anemia and iron deficiency, which occurred in 54.4% and 36.6% of the cases, respectively. Other observed nutritional deficits were: mild hypoalbuminemia in 20.3% of the patients, hypothrombinemia in 14.9%, folic acid decrease in 17.8%, vitamin B12 deficiency in 12.5%, hypocalcaemia in 23.8%, and secondary hyperparathyroidism in 45.4% of the cases. All nutritional complications were more frequent in patients submitted to biliopancreatic bypass, with the exception for vitamin B12 deficiency that occurred more frequently in patients with gastric bypass. The most frequently observed digestive complication was diarrhea/steatorrhea in 39.1% of the cases. Sixty-four point two percent of the patients considered the surgery outcome as excellent or very good.

CONCLUSIONS

In patients with morbid obesity, bariatric surgery is a technique by which a great improvement in anthropometrical parameters, cardiovascular risk factors, and quality of life of patients is achieved, but it associates an important percentage of nutritional complications that we should take into account in order to prevent them.