BOMSS nutritional guidance

BOMSS Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery

for and on behalf of BOMSS Council, October 2014
BOMSS Guideline Working Party

Mary O’Kane, Jonathan Pinkney, Erlend Aasheim,
Julian Barth, Rachel Batterham, Richard Welbourn

Summary

Bariatric surgery is now an essential option for the treatment of obesity and its associated comorbidity. Many patients presenting for surgery will have pre-existing vitamin deficiencies and all bariatric surgical procedures compromise nutrition to varying extents, and have the potential to cause clinically significant micronutrient deficiencies. Therefore, long term nutritional monitoring and follow-up are essential components of all bariatric surgical services. However, there are no current standard guidelines in the UK for the biochemical monitoring and replacement of essential micronutrients in patients undergoing different forms of bariatric surgery. Furthermore, a survey of members of BOMSS revealed a wide diversity of local guidelines and practices. This suggested a need for standard guidelines. We undertook a review of existing guidelines and the associated literature on micronutrient deficiencies following bariatric surgery. Our aim was to summarise existing evidence for the monitoring and replacement of vitamins and minerals prior to, and following bariatric surgery, and to make recommendations for safe practice in the UK setting. This publication is an abbreviated version of the fuller report.

Download the BOMSS Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery

BOMSS nutritional guidelines


BOMSS statement on MGBs

BOMSS has released a position statement on mini gastric bypass operations (MGBs).

In an MGB, the stomach is divided to form a long gastric pouch with subsequent anastomosis of that pouch to the jejunal loop. The narrow tube of gastric pouch affords a restrictive component and the bypassed small bowel contributes the malabsorptive element.

BOMSS has published a position statement on the use of MGBs which describes its benefits as including the requirement for a single anastomosis – making it a more technically simple operation than other options and one which has fewer potential sites for leaks and internal hernias.

Professor Duff Bruce, BOMSS member and consultant surgeon at Aberdeen Royal Infirmary, said; “Results to date suggest non-inferiority of MGB compared to the gold standard Roux-en-Gastric bypass in terms of mortality, weight loss, comorbidity resolution and quality of life.

“If the MGB is introduced into routine bariatric surgical practice it is recommended that it is within the confines of careful prospective data collection by surgeons working within the framework described in BOMSS Professional Standards guidelines. Follow-up data should be submitted to the National Bariatric Surgery Registry.”

Some potential disadvantages of MGBs have been noted and include the possible risk of reflux, a theoretical association between biliary reflux and oesophageal carcinoma and a lack of long-term outcome data.

BOMSS will review its MGB position statement after two years.


BOMSS unveils post-op poster for GPs

BOMSS has issued a traffic lights-style poster to help GPs care for patients who have had bariatric surgery.

Council member Mr Sean Woodcock designed the at-a-glance poster displaying a range of possible symptoms which will require referral back to bariatric specialists. Symptoms are categorised in traffic light colours to show whether they warrant emergency, urgent or routine attention. The poster – “Primary care management of post-operative bariatric patients” – also suggests how soon after an operation the symptoms are most likely to occur.

Mr Woodcock, consultant surgeon at Northumbria NHS Foundation Trust, said: “The poster will help GPs decide how urgent the situation may be if a patient presents symptoms following an operation and how quickly they should be referred back to a specialist.

“Bariatric procedures are often extremely beneficial to people with serious weight problems but like all operations there can be complications. This traffic lights-style poster will help GPs decide how serious any complications may be and help make sure they refer patients to a specialist in good time.”

The poster – Primary care management of post-operative bariatric patients can be viewed at http://www.bomss.org.uk/primary-care-management-of-post-operative-patients/