Practical tips for complaints after bariatric surgery
After obesity surgery, the gastrointestinal tract is often sensitive. Fortunately, simple dietary measures often help. An important part of long-term follow-up is the control of eating behavior and nutrition.
Bariatric surgery can do a lot of good in terms of weight loss and metabolic problems. However, such an intervention also requires a permanent and thorough change of eating habits - and adipose surgical candidates should be trained in advance.
It is advisable that the patients already know before the procedure about the postoperative diet (liquid phase, porridge phase, light diet), suitable portion sizes and healthy eating and drinking. Nevertheless, gastrointestinal complaints are common after bariatric surgery. What these are and what can be done about them, Dr. Tatjana Schütz from the University Medical Center Leipzig.
Nausea and vomiting occur in 30-60% of patients in the first postoperative months. Not infrequently this leads to dehydration. Causes are passage disturbances or an unadjusted eating behavior.
This helps: increase the fluid intake to at least 1.5 l per day and keep a drinking diary. Eat slowly, chew well, avoid strong smelling foods and pay attention to appropriate portion sizes. A thiamine deficiency can also lead to vomiting. Therefore, clarify this and if necessary supplement the vitamin.
Dysphagia (dysphagia, pressure and tightness after a quick meal) is mainly due to restrictive surgical procedures (for example, tubular stomach).
This helps: chew on enough (at least 15 times per bite) and eat slowly. Avoid dry, crumbly and fibrous foods (such as white bread, biscuits, beef). Prolonged dysphagia may require endoscopy.
Early dumping occurs about 30-60 minutes postprandially when the stomach empties quickly. It leads to the passage of intravascular fluid into the intestinal lumen, which can cause hypotension, tachycardia, flushing, nausea, pain and diarrhea.
This helps: Drink 30 minutes before eating to ensure a balanced hydration. Prefer complex carbohydrates, reduce refined carbohydrates. Increase protein and fiber in the diet. Use any viscosity-enhancing substances such as guar or pectin.
Late dumping is observed one to three hours postprandially and is associated with hypoglycemic symptoms (sweating, cravings, tremor, lack of concentration, somnolence).
This helps: take 10 g of sugar in the first postprandial hour.
Diarrhea and flatulence affect up to 40% of patients after bariatric surgery. It can lead to very frequent defecation and fatty stools.
This helps: reduce fat, fiber and possibly lactose (with secondary lactose intolerance), increase fluid intake and eat slowly. Avoid bloating foods such as cabbage, legumes and carbonated drinks, do without chewing gum (because a lot of air is swallowed). Use fennel, caraway and anise as tea or seasoning. If necessary, administer probiotics, loperamide, bile acid or pancreatic enzymes. Clarify if there is a bacterial overgrowth.
Constipation may develop with insufficient fluid intake or under the influence of certain supplements such as iron or calcium.
This helps: increase hydration (unsweetened drinks), increase dietary fiber (whole grains, fruits, vegetables). Crushed linseed, wheat bran or psyllium may make sense if you drink enough. Pay attention to regular exercise.
Food intolerances occur in some patients in the early postoperative period. Patients should be informed about this preoperatively.
This helps: eat small portions and chew thoroughly. The food that is currently not tolerated (for example, milk), leave out for a while and after some time check if the intolerance still exists.
Bariatrics and the desire to have children - is that right?
Obesity reduces fertility and, if the conception worked well, leads more often to pregnancy complications. Is a bariatric surgery the solution?
Many obese young women hope in vain for a spontaneous pregnancy. This is related to the fact that obesity is often associated with a hyperandrogenemia or polycystic ovarian syndrome (PCOS), said PD MD Christian Göbl, Medical University of Vienna. PCOS is often associated with increased insulin resistance and compensatory hyperinsulinaemia, which affect follicular growth and oocyte maturation, leading to decreased fertility.
Therefore, young, overweight women often need the help of reproductive medicine to fulfill their children's desire - and assisted reproductive technologies (ART) are much more likely to fail in the obese than in the lean. The higher the BMI, the greater the risk that ART will not lead to the desired baby.
Losing weight can help - that is why many obese women with an unfulfilled desire to have a baby choose a bariatric surgery. In fact, research shows that bariatric surgery can have a positive effect on hyperandrogenemia, and that up to 58% of women undergoing surgery experience spontaneous pregnancies after surgery.
But when is the right time for a pregnancy? After a gastric bypass surgery or after a sleeve gastrectomy (tube stomach), the woman should, if possible, pregnancy until one and a half years after the procedure plan, the speaker said. In the meantime, a safe contraceptive method should be chosen, but it should be noted that oral contraceptives may not be as reliable after the surgery (especially in the case of malabsorptive procedures) and that parenteral dosage forms may be safer.
Bariatric surgery affects the uptake of micronutrients and macronutrients, therefore women with children who have undergone an obesity surgery should be screened for deficiencies and substituted if necessary.
As further possible undesired effects of the operation, e.g. maternal anemia, an increased risk of intra-abdominal hernias, impaired glucose metabolism, and an increased risk of fetal growth restriction.
On the one hand, post-dumping hypoglycaemia may result in women giving birth to growth-retarded children more often after bariatric surgery. On the other hand, nutrient deficiencies of the mother, which also manifest on the unborn child, could be shown, as investigations of umbilical cord blood samples show.
To keep a close eye on fetal development, monthly ultrasound scans should be performed with a record of the unborn child's growth curve. Experts also recommend a connection to a perinatal center. If the child is born, the mother can be encouraged to breastfeed, with appropriate nutrient substitution during breastfeeding.