AB018. OP18 Malnutrition due to transit bipartition: reversal to sleeve gastrectomy

AB018. OP18 Malnutrition due to transit bipartition: reversal to sleeve gastrectomy

Mehmet Mahir Özmen, Emre Gündoğdu, Emir Güldoğan

İstinye University School of Medicine, Liv Hospital Ankara, Turkey

Correspondence to: Emre Gündoğdu. İstinye University School of Medicine, Liv Hospital Ankara, Turkey. Email: dremregundogdu@gmail.com.

Abstract: Transit bipartition with sleeve gastrectomy (TBSG) is a bariatric surgical technique using by many centers for metabolic and bariatric surgery. However, it may be associated with postoperative malnutrition. This case describes the clinical course and unfortunate outcome of a morbidly obese patient who underwent TBSG and developed malnutrition in the seventh postoperative month. A 67 year-old female patient with a BMI of 47 kg/m2 underwent TBSG surgery in another center in June 2018 and was discharged uneventfully. She presented with lower extremity edema, generalized skin eruptions, generalized weakness, nausea, vomiting 5 months later. She was admitted and received a high-protein diet, and her clinical condition was not improved. Two months after her discharge patient is admitted to our clinic. She was readmitted with the same complaints, as well as anemia, increased liver function tests, increased INR levels, decreased, selenium and zinc levels, hypocalsemia, hypophosphatemia and vitamin D, E insufficiency with a blood albumin level of 2.2 g/dL, compared to a normal preoperative value. After unsuccessful intensive supportive measures, she finally underwent revisional sleeve gastrectomy with a robotic approach. After a two week period all the symptomatic and laboratory parameters gone well. Multiple factors can contribute to postoperative malnutrition and liver dysfunction after TBSG, including the presence of baseline liver disease, inadequate diet supplementation, leaving a too-short common small intestinal channel, and ethnic variations in small bowel length. These factors should also be considered when deciding to perform corrective surgery. Careful, individualized treatment and follow-up plans may help to prevent such catastrophic consequences.

Keywords: Malnutrition; liver failure; revisional bariatric surgery; transit bipartition; sleeve gastrectomy


Provenance and Peer Review: This abstract is included in “Abstracts from the 3rd Turkish National Congress on Bariatric and Metabolic Surgery, 21st-24th November 2019, Antalya-Turkey”, which is commissioned by the editorial office for the series “Bariatric and Metabolic Surgery” published in Annals of Laparoscopic and Endoscopic Surgery. This abstract did not undergo external peer review.

Conflicts of Interest: The authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/ales-2019-bms-29). The series “Bariatric and Metabolic Surgery” was commissioned by the editorial office without any funding or sponsorship. MMÖ served as the unpaid Guest Editor of the series, and serves as an unpaid editorial board member of Annals of Laparoscopic and Endoscopic Surgery from Mar 2019 to Feb 2021. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

doi: 10.21037/ales-2019-bms-29
Cite this abstract as: Özmen MM, Gündoğdu E, Güldoğan E. Malnutrition due to transit bipartition: reversal to sleeve gastrectomy. Ann Laparosc Endosc Surg 2020;5:AB018.