This literature review embraces an analysis of gastric bypass in relation to alterations that can occur within the body after surgery and follow up care needed to avoid them. Precisely, an account of nutritional adjustments; implications for anemia; vitamin deficiencies, and malabsorption tendencies will be uncovered. In concluding recommendations and implications for evidence based practice will be discussed.
Nursing: Gastric Bypass Literature Review
Introduction
Subtopics chosen for this literature review exploration are nutritional considerations; anemia complication; vitamin deficiencies and malabsorption tendencies. Eight articles have been selected to describe these interests in the surgical intervention under scrutiny. They are ‘Nutritional Considerations after Bariatric Surgery’ by Kelly Elliot and Nutritional Concerns Related to Rou-en-Y Bypass by Jorge Vazquez. With regards to anemia, ‘Prevalence of Anemia Related Deficiencies in the First Year Following Laparoscopic Gastric Bypass in Morbid Obesity by Aarts and others along was the choice study for investigation
In the vitamin deficiency category three articles were chosen namely, Vitamin D in Adipose Tissue and Serum 25-Hydroxyvitamin D After Roux-en-Y Gastric Bypass by Pramyothin and others; Vitamin A Deficiency after Gastric Bypass Surgery: An Underreported Post-Operative Complication by Zalesin and others and Severe Hypocalcemia due to Vitamin D Deficiency after extended Roux-en-Y Gastric Bypass by Mi˜nambres and counterparts.
Related to absorption dysfunctions, Zinc Absorption and Zinc Status are Reduced After Rou-en-Y gastric Bypass Surgery by Ru and team mates and ‘True Fractional Calcium Absorption is Decreased After Roux-En-Y Gastric Bypass Surgery by Riedt and associates were chosen for chosen for review. The collective significance of these studies to this literature review analysis is that they address the research concerns of this author.
Individually, studies on nutrition clarify the importance of patients and clinicians understanding changes, which occur due to this surgical intervention. These studies provide evidence based applications to appropriately address the initial side effect of gastric bypass in avoiding precipitating complications that follow.
Studies on anemia are relevant since this is another determinant as to whether the surgery is successful or not. If there are no evidence based data to interpret this dysfunction gastric bypass surgery would then be perceived a failure if patients become anemic and die. This study interprets the causes and suggests intervention strategies.
Likewise vitamin deficiencies and anemia clasp hands. They are two sides of the same coin. The study relates to vitamin A deficiency particularly, which could sequel many other complications if not treated appropriately or even recognized as the study suggests. The aim of this research project was to expose this ignored complication of gastric bypass. Beginning from the point of nutritional considerations as a prophylactic intervention for all gastric bypass complications, ultimately the issue of tendencies towards malabsorption must be investigated. These studies explored the malabsorption of zinc being and important trace element for the absorption of many other vitamins in the body. They validate the significance of all other research articles selected for this review.
The selection process entailed searching data bases for Journal articles containing studies related to gastric bypass. Data bases included PubMed, Google Scholar and Surgical Gasrtroentology web sites.
The inclusion criteria emerged from exploring concepts related to after gastric surgery care implications. Key words were nutritional considerations; predisposing factors for anemia; vitamin deficiencies and malabsorption tendencies pertaining to gastric bypass surgery. Obvious exclusion criteria were articles and studies which did not address gastric bypass neither after care implications (See Worksheet)
Gastric bypass surgery is becoming increasingly popular in the United States of America. According to research studies obesity has become an epidemic among children and adults alike across the nation. When all measures of diet, exercise and modification of life style fails the alternative is gastric bypass. However, this is not without consequences. This literature review will attempt to explore the details of these consequences based on incidences of occurrences after surgery.
It would be highlighted from the following literature review that nutrition ranks high in aftermath of gastric bypass surgery. The surgery in itself forces patients towards changes in appetite. One may tend to eat less or even fast due to a lack desire for indulgence in food. This is the foremost complication arising from surgery. The sequel to altered nutrition obviously is anemia. Anemia even though is iron deficiency mainly; vitamins can affect the severity of the iron deficiency. Ultimately, a need to research and identify mal-absorption tendencies could greatly influence the outcome of gastric bypass surgery. As such, it is within this prioritized framework that an integrated literature review would be embraced.
Literature Review
Kelly Elliot (2003) contends that mal-nutrition is associated with all bariatric surgeries. This conclusion was derived after she conducted studies to prove it prevalence. Two types of bariatric surgeries were discussed in the article as it relates to prevalence of malnutrition. First it was the restrictive type and the other malabsorptive (Elliot, 2003).
Further she advances, with regard to examining the value of her article to my literary exploration, that malnutrition after gastric bypass surgery is preventable once nutrion education is offered before and follow up nutrion education becomes a priority for nurses. She emphasized the need for patients’ compliance with chewing food and slowing down the eating pace (Elliot, 2003).
Shuster and Vazquez (2005) similarly, cited that postoperative nutrition management is essential towards successful surgical outcomes. The researchers highlighted a number of nutritional deficiencies in the categories of protein calorie intake as well as an array of vitamins and minerals irregularities. It was predicted that malnutrition inhibits the quality of life by putting these patients at risks of chronic diseases (Shuster & Vazquez, 2005).
Precise discoveries from their studies that vitamin and mineral intake of post-operative clients being monitored over 1-2 years were below RDA level. Even though their nutritional status appeared normal there were marked deficiencies in iron, vitamin B1 and folic acid. Dumping syndrome, Wernicke s encephalopathy, and peripheral neuropathy were noted as common complications of mal-nutrition after gastric bypass surgery. In the long term nutritional follow is imperative as it pertains to the value of this literature review (Shuster & Vazquez, 2005).
Prevalence of Anemia Related Deficiencies in the First Year Following Laparoscopic Gastric Bypass in Morbid Obesity by Aarts and others was the study selected for investigating anemia as a serious complication of gastric bypass surgery. The researchers discovered that anemia after gastric bypass was associated with iron, folic acid and vitamin B12 deficiency. They attributed this dysfunction to the malabsorption techniques used in performing bypass surgery (Arts et.al, 2011).
Their studies involved 416 postoperative patients during 2005-2009. Before surgery 7%o of these patients were anemic. Following up after 12 months 66% developed anemia. 93 patients from this sample developed anemia during the first year. Iron deficiency was observed to be the greatest source of anemia (Arts et.al, 2011).
In the vitamin deficiency category Pramyothin (2011) and his counterparts investigated vitamin D concentration in abdominal fat of obese patients after gastric bypass surgery. They sampled 11 patients. A high- performance liquid chromatography (HPLC) was used to measure Adipose vitamin D2 and vitamin D3 concentrations. The researchers concluded that ‘vitamin D in adipose tissue does not significantly contribute to serum 25(OH)D despite dramatic loss of fat mass after RYGB’ (Pramyothin et.al, 2011).
Vitamin A Deficiency after Gastric Bypass Surgery: An Underreported Post-Operative Complication by Zalesin ( 2010) and his counterparts was perceived as valuable understanding the importance of after caring for patients with gastric bypass. These researchers conducted a retrospective chart review in establishing a positive relationship ‘between serum vitamin concentration and markers of protein metabolism at 6-weeks and 1-year post-operatively’ (Zalesin et.al.2010). They concluded that measures should be adapted to evaluate patients post operatively for serum vitamin A deficiencies (Zalesin et.al.2010).
Mi˜nambres (2010) and his team conducted studies actually contracting the theory that gastric bypass does not affect vitamin D production due to loss of adipose tissue. The researchers contend that routine screening for patients who have had gastric bypass is imperative. Inadequate vitamin D is a predisposing factor for hypocalcaemia, they discovered from research studies. This is important after care knowledge for intervention purposes (Mi˜nambres, 2010)
Ru (2011) and his teammates contend that micro nutrients are a common complication of gastric bypass. However, this is associated with after surgery malabsorption syndrome even when the surgery itself does not inhibit adsorption. The researchers advance that zinc adsorption would be less after surgery. Results proved that zinc absorption is significantly impaired after surgery even when it is administered orally. This could contribute to nutritional deficiencies in the long-term (Ru.et.al, 2011)
Riedt (2006) and her counterparts support previous studies showing where calcium absorption is compromised as depletion in the manufacture of various vitamin and trace element occur. They conducted studies on 21 post gastric surgery women. Stepwise linear measurements were applied in the analysis of data Results were that alteration in calcium metabolism after gastric bypass regulated estradiol level, which ultimately could lead to bone loss (Riedt et.al, 2006).
All of these studies collectively and individually support each other in identifying that nutritional irregularities occur after gastric bypass surgery. This is influenced by the surgery itself through malabsorption issues or induced from inadequate management post-operatively.
Notable gaps in the body of knowledge presented in this foregoing integrated literature review pertains to how soon should nutrition education practice begin prior to surgery. Since the concern of this researcher is after care the question of how could adequate preparation influence after care intervention and outcomes. From an Advanced Nursing perspective these answers were not clear from the studies reviewed. It is obvious that research pertaining to appropriate after care nursing strategies ought to be conducted.
Conclusion
This analysis of literature presents valuable data for advanced nursing practice. It is highly recommended that more in-depth studies regarding immediate postoperative interventions as a prophylaxis for nutritional deficiencies; anemia; vitamin malabsorption syndrome and malabsorption dysfunctions indirect relation to surgery prevention absorption.
There is scientific evidence supportive of significant changes occurring in nutrition which is fundamental to all bypass surgeries. There is also evidence to prove that with inadequate or alterations in nutrion serious complications occur which can reduce life expectancy patients if not addressed initially. The implication is for surgeons and Advanced Nurses to address these issues in their clinical practice to make the necessary changes.
Aarts, O. vanWageningen, B. Janssen, C.,1 & Berends F. ( 2012). Prevalence of Anemia and
Related Deficiencies in the First Year following Laparoscopic Gastric Bypass
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Elliot, K. (2003). Nutritional Considerations after Bariatric Surgery. Critical Care Nursing
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Mi˜nambres,1, Chico, A., & P´erez A.(2011). Severe Hypocalcemia due to Vitamin D
Deficiency after Extended Roux-en-Y Gastric Bypass. Journal of Obesity
Article ID 141024,
Pramyothin, P. Biancuzzo, M. Lu, Z. Hess, D. Apovian, C., & Holick, M (2011). Vitamin D in
Adipose Tissue and Serum 25-Hydroxyvitamin D After Roux-en-YGastric Bypass.
Obesity Journal, 19(11), 2228-2234.
Riedt,C. Brolin, R. Sherrell R. Field,M., & Shapses, S. (2005). True Fractional Calcium
Absorption is Decreased After Roux-En-Y Gastric Bypass Surgery.Obesity,14(11),
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Ruz, M. Carrasco, F., & Rojas, P. (2011). Zinc absorption and zinc status are reduced after
Roux-en-Y gastric bypass: a randomized study using 2 supplements. USA. American
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Shuster, M., & Vazquez, J. (2005). Nutritional Concerns Related to Roux-en-Y Gastric
Bypass:What Every Clinician Needs to Know. Crit Care Nurs Q
28,( 3), 227-260
Zalesin, K .Miller, W., & Franklin, B. (2011). Vitamin A Deficiency after Gastric Bypass
Surgery: An Underreported Postoperative Complication. Journal of Obesity
Article ID 760695.
