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Emerging evidence suggests that sleeve gastrectomy (SG) leads to significant bone mineral density (BMD) losses, but there is a paucity of studies evaluating skeletal consequences beyond 12-months post-operatively. To evaluate BMD changes 2 years postoperatively. A university hospital. Thirty-three women (mean age: 34.4 ± 12.3 years) who underwent SG and completed 24 months of follow-up were evaluated prospectively at baseline and at 3 (M3), 6 (M6), 12 (M12), and 24 (M24) months postoperatively. Data collected included BMD at the total hip, femoral neck, and lumbar spine measured by dual-energy x-ray absorptiometry and anthropometrics, biochemical, nutritional, and physical activity parameters. At M24, patients achieved a mean body mass index and excess weight loss of 32.4 ± 5.1 kg/m2 and 64.5 ± 21.4%, respectively; however, weight stabilized at M12. Femoral neck BMD decreased significantly from baseline to M24 (.924 ±.124 versus.870 ±.129 g/cm2, P <.001), with no change between M12 and M24 (P =.273). Total hip BMD decreased significantly from baseline to M24 (1.004 ±.105 versus.965 ±.132 g/cm2, P <.001) but increased between M12 and M24 (P =.001). No significant changes were noted in lumbar spine BMD. The percentage of changes in the femoral neck and the total hip BMD from baseline to M24 positively correlated with postoperative excess weight loss (r =.352, P =.045, and r =.416, P =.018, respectively). Despite notable weight loss, women who underwent SG experienced significant bone loss at the total hip and femoral neck more than 2 years postoperatively. Future studies should investigate intervention strategies to attenuate skeletal deterioration after SG. [Display omitted] • We assessed bone mineral density (BMD) in women 2-years post-sleeve gastrectomy (SG). • Mean excess weight loss (EWL) achieved at two years was 64.5 ± 21.4%. • SG was associated with reduced BMD of the hip and femoral neck. • The greatest BMD deterioration occurred predominantly during the first year. • Higher EWL was associated with femoral neck and total hip BMD declines. [ABSTRACT FROM AUTHOR]

Data are scarce regarding outcomes of pregnancies occurring very early after bariatric surgery. We compared outcomes of pregnancies occurring extremely early (surgery-to-conception interval <6 mos) after laparoscopic sleeve gastrectomy (LSG) with those occurring later (≥6 mos postsurgery). A university hospital. We reviewed the records of all women who underwent LSG and delivered during 2006–2019. Of 196 women, 23 (11.7%) became pregnant within 6 months of surgery. For these women, the median surgery-to-conception interval was 116 [interquartile range 76–161] days, compared with 903 [465–1377] days for the remaining cohort. Three (13.0%) women turned out postoperatively to be pregnant at the time of LSG. Compared with women who conceived later, the extremely early pregnancy group had lower gestational weight gain (median 4 versus 10 kg, P <.001), including negative gestational weight gain in 9 (39.1%) women. The proportion of small for gestational age (SGA) infants was higher among women who conceived within 6 months after surgery rather than later (26.1% versus 10.4%, P =.04). Other maternal and perinatal outcomes were similar between the groups. In multivariate analysis, conceiving within 6 months after LSG was the only independent factor associated with delivering a SGA infant (odds ratio [95% confidence interval]: 3.35 (1.12, 10.01), P =.03). Pregnancy occurring in the first 6 months after LSG was independently associated with a higher rate of SGA infants. Delaying conception during the very early postoperative period is recommended. Providing adequate contraception and excluding the presence of early pregnancy at the time of surgery are of utmost importance. • Outcomes of pregnancy occurring in the very early postoperative period after bariatric surgery have not been established. • A review of 196 women who conceived after sleeve gastrectomy (SG), including 23 pregnancies within 6 months after surgery. • An increased risk for small-for-gestational age infant was observed in those who conceived in the first 6 months after SG [ABSTRACT FROM AUTHOR]

Women of childbearing age constitute a substantial proportion of the patients who undergo weight loss procedures. However, little is known regarding attitudes and behaviors of women during pregnancy after bariatric surgery (BS). We explored women's experience and behavior during pregnancy after BS. University hospital. A cross-sectional survey study was performed among women who underwent sleeve gastrectomy and delivered at our center. Overall, 111 women completed the questionnaire (response rate 88.1%). The median surgery-to-conception interval was 34 (25–50) months. For 28 (25.2%) women, future pregnancy was a motivation for undergoing the weight loss procedure. Only 10 (9.0%) received contraceptive advice perioperatively. Oral contraception was the most commonly used method after surgery (n = 47, 42.3%). Pregnancy was reported as unintended by 37 (33.3%) women. Only 14 (12.6%) women stated receiving an explanation regarding the implications of BS on pregnancy outcomes. Rates of follow-up with maternal-fetal medicine specialists, bariatric surgeons, and dieticians during pregnancy were 36.0%, 9.0%, and 23.4%, respectively. Forty-four women (39.6%) felt follow-up throughout gestation was inadequate. Satisfaction from BS improved after pregnancy in 23 (20.7%) women, and 75 (67.6%) stated that they would recommend BS to a friend with obesity who plans to conceive in the future. Women reported insufficient knowledge regarding the expected outcomes of pregnancy after surgery, with low rates of medical and nutritional follow-up. Only a minority of respondents received contraceptive advice after surgery, and unintended pregnancies were common. These observations represent areas of improvement for following women of childbearing age who undergo weight loss procedures. [ABSTRACT FROM AUTHOR]

Women of childbearing age constitute a substantial proportion of patients who undergo weight loss procedures. However, little is known regarding family planning knowledge, attitudes, and practices among bariatric surgeons. We explored the reproductive health and contraceptive practices among bariatric surgeons. A national society of bariatric surgeons. A cross-sectional study. Anonymous surveys were sent to all members of the Israeli Society for Metabolic and Bariatric Surgery. The Israeli Society for Metabolic and Bariatric Surgery survey elicited a response rate of 96% (n = 48). Most (89.6%, n = 43) considered female reproductive health perioperative counseling very important, and the majority of respondents (66.7%, n = 32) felt comfortable discussing these issues. Nevertheless, only 54.2% (n = 25) reported routinely having family planning and pregnancy conversations with their patients. There was a general awareness that women should delay conception after surgery; however, only a minority of bariatric surgeons consistently either recommended the use of contraception after surgery (39.6%, n = 19) or referred patients for contraceptive advice (25.0%, n = 12). Most (81.3%, n = 39) practitioners reported not having accurate knowledge of contraception and felt that collaboration with other bariatric healthcare providers would provide patients with optimal reproductive-health counseling. Bariatric surgeons acknowledged the importance of reproductive healthcare and the need to delay conception among women undergoing bariatric surgery. However, they inconsistently addressed family planning and contraceptive issues and reported lack of accurate knowledge in this regard. This highlights the need for multidisciplinary collaboration between bariatric healthcare providers to improve reproductive and contraceptive care in these patients. • A cross-sectional reproductive-health survey of members of the Israeli Society for Metabolic and Bariatric Surgery. • Bariatric surgeons acknowledged the importance of reproductive-health care and the need to delay conception among women undergoing BS. However, they inconsistently addressed family planning and contraceptive issues and reported lack of accurate knowledge in this regard. • This highlights the need for multidisciplinary collaboration between bariatric health-care providers in order to improve reproductive and contraceptive care in these patients. [ABSTRACT FROM AUTHOR]

Reproductive-aged women constitute a substantial proportion of patients who undergo weight loss procedures. While the risk of gallstone disease after such procedures has been addressed extensively, the impact of pregnancy on gallstone disease after bariatric procedures has not been reported. To explore the effects of pregnancy on cholecystectomy rates after laparoscopic sleeve gastrectomy (LSG). A university hospital. A cross-sectional cohort study of reproductive aged women (18–45 yr) who underwent LSG. The association between pregnancy and cholecystectomy was evaluated with Cox regression analysis. Of 1056 women of childbearing age who underwent LSG during 2006–2017, 128 (12.1%) subsequently experienced a pregnancy. Median follow-up durations were 3.9 and 4.9 years for women who did and did not conceive, respectively (P <.001). The median time from procedure to conception was 509 (374–1031) days. Overall, 117 (11.1%) women underwent cholecystectomy after LSG. The rate of cholecystectomy among those who conceived was higher than among those who did not (18.8% versus 10.0%, P =.005). In an unadjusted analysis, pregnancy was associated with an increased risk of cholecystectomy (hazard ratio [95% confidence interval]: 3.97 [2.58, 6.09], P <.0001). The association between pregnancy and cholecystectomy persisted after controlling for confounding factors (hazard ratio [95% confidence interval]: 3.82 [2.47, 5.92], P <.0001). Among those who experienced pregnancy, lower gestational weight gain was the only factor found to be associated with cholecystectomy after surgery (P =.05). Pregnancy is associated with a 4-fold increased risk of cholecystectomy after LSG. Thus, the desire for future pregnancy should be considered before LSG. • A cross-sectional cohort study of 1056 reproductive-aged women who underwent sleeve gastrectomy. • Cholecystectomy was performed in 18.8% of those who conceived vs. 10.0% of those who did not (HR [95% CI]: 3.82 (2.47, 5.92), P<0.0001). • Lower gestational weight gain was associated with cholecystectomy following surgery. [ABSTRACT FROM AUTHOR]

• Twin pregnancy outcomes following bariatric surgery (BS) are unknown. • Twin pregnancies were compared between 22 post-BS women and 44 matched controls. • Gestational diabetes and hypertensive disorders were less prevalent following BS. • Neonatal birthweights did not differ, but weight discordance was less post-BS. The effect of bariatric surgery (BS) on twin pregnancy outcomes is unclear. We examined associations of BS with maternal and perinatal outcomes among women with twin gestation. A university hospital. A retrospective case-control study of twin deliveries during 2006 through 2017. The study group comprised all women with twin pregnancy who had undergone BS and delivered during the study period. A control group was established by matching preoperative body mass index, age, parity, and delivery year. Data from 66 women with twin gestation were analyzed, 22 postBS and 44 matched control parturients. Compared with the control group, the study group had lower rates of gestational diabetes (9.1% versus 36.4%, P =.02) and gestational hypertensive disorders (0% versus 25.0%, P =.01); hemoglobin levels were lower at both early pregnancy (median 12.3 versus 13.4 g/dL, P <.001) and after delivery (9.3 versus 10.5 g/dL, P <.001). Median neonatal birthweights and the proportion of small-for-gestational-age infants were comparable between the groups. The degree of birth weight discordance between the twins was higher (17.2% versus 8.8%, P <.001) in the control group. In this study involving twin gestations, pregnancy outcomes were more positive among women who had undergone BS; as noted by reduced prevalences of gestational diabetes and gestational hypertensive disorders as well as a lesser degree of birth weight discordance. Nevertheless, BS was associated with lower hemoglobin levels during pregnancy and the postpartum period. Future studies are warranted to confirm our findings and evaluate the long-term outcomes of newborns of postBS mothers. [ABSTRACT FROM AUTHOR]

Highlights • Maternal nutritional status following bariatric surgery and its association with pregnancy outcomes. • A systematic review of the literature was performed, with 27 articles meeting the inclusion criteria. • Various micronutrient deficiencies were common among pregnant post-bariatric surgery patients. • Nevertheless, despite the concern that these deficiencies could adversely affect pregnancy outcomes (e.g. lower neonatal birth weight), evidence of such is lacking. Abstract Up to 80% of patients who undergo bariatric surgery are women of childbearing age. Coupled with improved fertility in women with obesity after bariatric surgery, pregnancy postbariatric surgery has become increasingly more common. Although numerous studies have evaluated associations of bariatric surgery with pregnancy outcomes, the effect of maternal nutritional status on maternal and perinatal outcomes is not well established. We used Medline and Embase databases and a manual search of references for articles published until June 2018 to conduct a systematic review on nutritional status after bariatric surgery and its association with maternal and perinatal outcomes. Of the 306 initially identified articles, 27 met the study inclusion criteria, comprising 2056 women with pregnancies after bariatric surgery. Deficiencies were reported in maternal concentrations of vitamins A, B1, B6, B12, C, D, K, iron, calcium, selenium, and phosphorous. The only adverse events documented for these deficiencies encountered during pregnancy were anemia (vitamin B12, iron), night blindness (vitamin A), and urinary tract infections (vitamin A, D). This systematic review suggests that various micronutrient deficiencies are common among pregnant postbariatric surgery patients. Nevertheless, despite the concern that these deficiencies could adversely affect pregnancy outcomes (e.g., lower neonatal birth weight), evidence of such is lacking. Further prospective studies are warranted to confirm our findings and better delineate the optimal supplementation regimen during pregnancy after bariatric surgery. [ABSTRACT FROM AUTHOR]

Abstract Background The optimal timing of pregnancy after bariatric surgery has not been established, with data limited regarding laparoscopic sleeve gastrectomy (LSG), currently the most common bariatric operation performed. Objectives We explored associations of the surgery-to-conception interval with pregnancy outcomes after LSG. Setting A university hospital. Methods We assessed pregnancy outcomes in relation to the surgery-to-conception interval for all women who underwent LSG and delivered during 2006 to 2018. Results Of 154 patients, 67 (43.5%) conceived within the first 18 months postoperatively (early-pregnancy group), whereas 87 (56.5%) conceived later (late-pregnancy group). The median surgery-to-conception interval was 390 (interquartile range 247–459) days in the early-pregnancy group and 1104 (8527–1548) days in the late-pregnancy group. Compared with the early-pregnancy group, the late-pregnancy group had higher gestational weight gain (median 11 versus 8 kg, P <.001) and lower hemoglobin levels in early pregnancy (12.3 versus 12.6 g/dL, P =.03) and after delivery (10.0 versus 10.4 g/dL, P =.02). Other maternal and perinatal outcomes were similar between the groups, including the proportion of small-for-gestational-age infants (11.9% versus 14.9%, P =.64) for those who conceived within or later than 18 months after surgery. Similar rates of small-for-gestational-age infants were found between those who conceived within or ≥12 months after surgery (P = 1.0). Conclusions Timing of pregnancy after LSG was found not to be associated with pregnancy outcomes. Together with documentations of a similar safety profile of pregnancy occurring earlier or later in the postoperative course, these data should reassure women who do not wish to delay conception after surgery. [ABSTRACT FROM AUTHOR]

Highlights • Pregnancy's long-term effect on outcomes after sleeve gastrectomy (SG) are unknown. • 80 patients who conceived after SG were matched to 80 patients who did not conceive. • Pregnancy did not adversely affect weight loss or comorbidity outcomes. Abstract Background Pregnancy outcomes after bariatric surgery have been addressed extensively; however, the impact of pregnancy on long-term outcomes after bariatric surgery has only been sparsely studied. Objectives We explored the effects of pregnancy on weight loss outcomes after laparoscopic sleeve gastrectomy (LSG). Setting University hospital. Methods A cross-sectional case-control study. Eighty women who became pregnant after LSG were matched by preoperative body mass index, age, and follow-up duration to 80 post-LSG patients who did not conceive after surgery (control group). Results The median follow-up duration was 5.2 years for the study group and 5.3 years for the control group (P =.73). For the study group, the median time from surgery to conception was 508 (interquartile range 372–954) days and the median gestational weight gain was 9 (6–12) kg. Comparing the study with the control group, median percentage total weight loss was similar, 31% versus 30% (P =.77); as was percentage excess weight loss (EWL%) 72% versus 71% (P =.77). For the study group, a multivariable analysis showed EWL% at the end of follow-up to be directly correlated with the lowest EWL% achieved before pregnancy (β =.78, P <.0001), and inversely correlated with time lapsed from surgery (β = −.26, P <.0001); yet EWL% was not found to be associated with surgery-to-conception time interval, gestational weight gain, breastfeeding, co-morbidities, smoking, occupational status, physical activity, and dietary habits. Conclusions Pregnancy after LSG does not affect long-term weight results. Coupled with the positive reports of improved pregnancy outcomes after bariatric surgery, these data should reassure women who wish to conceive after surgery. [ABSTRACT FROM AUTHOR]

Background While hypoglycemia during an oral glucose tolerance test (OGTT) has been shown to occur in a considerable portion of nonpregnant post–bariatric surgery (BS) patients, its incidence among pregnant post-BS patients evaluated for gestational diabetes has only been sparsely studied. Objectives We investigated OGTT results and pregnancy outcomes in pregnant women who underwent 3 types of bariatric procedures before pregnancy. Setting A university hospital. Methods From medical records, data were collected on glucose measurements during a 100-g, 3-hour OGTT, as well as maternal and fetal outcomes. Results Of 119 post-BS pregnant patients included in the study, 55 underwent laparoscopic sleeve gastrectomy, 34 laparoscopic adjustable gastric banding, and 30 laparoscopic Roux-en-Y gastric bypass surgery. Hypoglycemia (<55 mg/dL) was encountered in 59 (49.6%) patients during the OGTT. Among them, the nadir plasma glucose levels occurred 2 hours after glucose ingestion in 25 (42.4%) and after 3 hours in 34 (57.6%), with a median value of 47 (44–52) mg/dL. The risk of hypoglycemia was higher among women with prior laparoscopic Roux-en-Y gastric bypass surgery (83.3%) than among those with prior laparoscopic sleeve gastrectomy (54.5%; P = .009) or laparoscopic adjustable gastric banding (11.8%; P <.0001). Time from surgery to conception was significantly shorter among women with evidence of hypoglycemia during OGTT (median 711 versus 1246 days, P = .002). Compared with patients without evidence of hypoglycemia, patients who experienced hypoglycemia had lower rates of gestational diabetes ( P = .03) but higher proportions of low birth weight ( P = .01) and small for gestational age infants ( P = .03). Conclusions Because hypoglycemia is common during OGTT among post-BS parturients, other diagnostic methods should be considered in this setting. The association found between hypoglycemia and poor fetal growth warrants investigation as to whether interventions to prevent hypoglycemia will improve fetal outcome. [ABSTRACT FROM AUTHOR]

Background Bariatric surgery is associated with increased thromboembolic risk, which may extend well beyond hospital stay. The hemostatic mechanisms implicated in this risk are not well established. Objectives We aimed to determine the dynamics of hemostatic changes and procoagulant potential among patients undergoing laparoscopic sleeve gastrectomy, during both the early and late postoperative periods. Setting A university hospital. Methods Patients who underwent laparoscopic sleeve gastrectomy were recruited consecutively to this study. Blood samples were taken preoperatively, before discharge (postoperative day [POD] 3), and at the first follow-up visit (POD10). All samples were tested for complete blood count, C-reactive protein, von Willebrand factor, factor VIII, fibrinogen, and thrombin generation. Results The median preoperative body mass index of the 26 participants was 41.3 (38.7–43.3) kg/m 2 . Compared with preoperative evaluation, fibrinogen, von Willebrand factor antigen and activity, and factor VIII levels were significantly higher at POD3 and POD10 ( P <.0001 for all comparisons). Peak thrombin levels and endogenous thrombin potential (ETP) were higher at POD3 ( P = .005 for both comparisons) and POD10 ( P = .0009 and<.0001) compared with baseline. ETP and peak thrombin, as well as fibrinogen, von Willebrand factor, and factor VIII levels, were comparable between POD3 and POD10. Multivariate analysis showed that the only predictor of postoperative ETP was the preoperative ETP level (β = .55, P = .007). Conclusions As determined by thrombin generation, laparoscopic sleeve gastrectomy was associated with hypercoagulability, which persisted during POD10. This finding suggests a possible benefit of extended thromboprophylaxis. Nevertheless, our results should be interpreted with caution due to the lack of a control group. [ABSTRACT FROM AUTHOR]

Background Data regarding long-term nutritional deficiencies following laparoscopic sleeve gastrectomy (LSG) are scarce. Objectives To assess the prevalence of nutritional deficiencies and supplement consumption 4 years post-LSG. Setting Hebrew University, Israel. Methods Data were collected prospectively from preoperative and 1 and 4 years postoperative including anthropometric parameters, biochemical tests, and supplement intake. Results Data were available for 192, 77, and 27 patients at presurgery and 1 and 4 years post-LSG, respectively. Prevalence of nutritional deficiencies at baseline and 1 and 4 years postsurgery, respectively, were specifically for iron (44%, 41.2%, 28.6%), anemia (11.5%, 20%, 18.5%), folate (46%, 14.3%, 12.5%), vitamin B12 (7.7%, 13.6%, 15.4%), vitamin D (96.2%, 89%, 86%), and elevated parathyroid hormone (PTH) (52%, 15.4%, 60%). Vitamin D levels remained low throughout the whole period. PTH levels were 37.5 pg/mL at 1 year postsurgery and increased to 77.3 pg/mL at 4 years postsurgery ( P = .009). Females had higher prevalence of elevated PTH and a tendency for higher rates of anemia, compared with males 4 years postsurgery (80% versus 20%, P = .025; and 28% versus 0%, P = .08, respectively). Of the patients, 92.6% reported taking a multivitamin and 74.1% vitamin D supplements during the first postoperative year, while after 4 years only 37% and 11.1% were still taking these supplements, respectively. Conclusion A high rate of nutritional deficiencies is common at 4 years post-LSG along with low adherence to the nutritional supplementation regimen. Long-term nutritional follow-up and supplementation maintenance are crucial for LSG patients. Future studies are needed to clarify the clinical impact of such deficiencies. [ABSTRACT FROM AUTHOR]

Background Thrombotic events involving the portal-splenic-mesenteric venous system (PSMVT) are rare but potentially lethal after bariatric surgery. Objectives To investigate the incidence, clinical presentation, management, and outcome of thrombotic events after bariatric surgery. Setting Two university hospitals. Methods A retrospective review of individuals who underwent bariatric surgery between January 2006 and December 2015. Results Overall, 4386 patients underwent bariatric surgery (laparoscopic sleeve gastrectomy [LSG; n = 2886], laparoscopic Roux-en-Y gastric bypass [n = 762], laparoscopic adjustable gastric banding [n = 668], and biliopancreatic diversion [n = 70]). Mechanical (thigh-length pneumatic compression stockings) and pharmacologic thromboprophylaxis (40 mg enoxaparin daily, starting 12 hours after surgery until discharge) was provided for all patients. A minority of patients (n = 543, 12.4%) also received an extended course of enoxaparin for 1–4 weeks after discharge. We observed 16 cases of PSMVT, all after LSG, with an incidence of .55% (16/2886). Twelve additional patients experienced deep vein thrombosis and 6 had pulmonary embolism. Follow-up imaging indicated complete resolution in all cases, with no sequelae, recurrent thrombosis, or mortality. The overall thrombosis rate was significantly lower in patients who received an extended course of anticoagulation after LSG ( P = .01) and after any type of bariatric surgery ( P = .02). Conclusions PSMVT was found to occur uncommonly after LSG. Prompt diagnosis and anticoagulation therapy led to favorable outcomes in most cases. Significantly lower rates of thrombosis were found in patients who received an extended course of anticoagulation. We support its use for at least 1 week after discharge. [ABSTRACT FROM AUTHOR]

Bezoars are collections of undigested foreign material that accumulate in the gastrointestinal tract. The most common are phytobezoars, which are formed from plant fibers, especially those related to the ingestion of persimmon. Patients who undergo abdominal surgery, including bariatric surgery for obesity, and particularly gastrectomy, are prone to bezoar formation due to reduced gastric motility, loss of pyloric function, and hypoacidity. Bezoars can form months to years postoperatively. Our objective was to review the published literature regarding phytobezoar formation after bariatric surgery. We investigated the entire scientific literature on phytobezoars as a complication after bariatric surgery using PubMed and Embase searches of all reports published to date. We used the following keywords: “phytobezoars” or “bezoars” and “bariatric surgery” or “laparoscopic adjustable gastric band” or “laparoscopic sleeve gastrectomy” or “Roux-en-Y gastric bypass” or “single anastomosis gastric bypass” or “biliopancreatic diversion.” Seventeen eligible articles were included in the study. We provide an overview of the incidence, classification, and manifestations of bezoar formation as a rare, late morbidity of bariatric surgery. Treatment options include chemical enzyme therapy, endoscopic dissolution and removal, or surgery. Nutritional counseling regarding bezoar formation and prevention of recurrence after bariatric surgery should emphasize changing eating habits, including sufficient drinking and chewing and avoiding the overindulgence of foods with high-fiber content, especially citrus pith and persimmons. Clinicians should be aware of this potential rare complication. Additional studies are needed to examine the eating habits and food choices of bariatric patients with bezoar complications and to elucidate more clearly the risk factors for this pathologic condition. [ABSTRACT FROM AUTHOR]

Background Nutritional deficiencies are common among morbidly obese patients. Data are scarce for patients who have undergone laparoscopic sleeve gastrectomy (LSG). Objectives The aim of the study is to clarify the prevalence of deficiencies and to identify risk factors for postoperative deficiencies. Settings Hebrew University, Israel. Methods Preoperative and 1-year postoperative data were collected. We included anthropometric parameters, obesity-related co-morbidities, and laboratory findings. Results There were 192 candidates. Seventy-seven of them completed follow-ups at 12 months. Before surgery, 15% had anemia. Deficiencies of iron, folate, and B12 were 47%, 32%, and 13%, respectively. Women were more deficient in iron (56% women, 26% men, P <.001). Before surgery, low levels of vitamin D and elevated parathyroid hormone (PTH) were 99% and 41%, respectively. One year postsurgery, the deficiencies of hemoglobin and vitamin B12 worsened (20% and 17%, P <.001, P = .048, respectively). One year postsurgery, deficiencies of iron, folate, vitamin D, and PTH improved (28%, 21%, 94%, and 10%, respectively). Deficiencies of hemoglobin, folate, and B12 before surgery were predictors for deficiencies 1 year after surgery ( P = .006 OR = .090; P = .012 OR = .069; P = .062 OR = .165, respectively). Conclusions LSG had a modest effect on nutritional deficiencies in our patients at 1-year postsurgery. Focusing on the preoperative nutritional status and tailoring a specific supplemental program for each individual should prevent postoperative deficiencies. [ABSTRACT FROM AUTHOR]

Abstract: Background: Due to high prevalence of type 2 diabetes mellitus (T2DM) and increasing popularity of bariatric and metabolic operations, Surgeons are faced with patients with relatively more severe T2DM disease. High level of glycated hemoglobin (HbA1c) is widely considered as a marker for uncontrolled T2DM. The aim of this study was to explore the correlation between high level of pre-operative HbA1c, peri-operative morbidity and post operative outcome after laparoscopic sleeve gastrectomy. Methods: We conducted a retrospective study based on our medical center metabolic and bariatric registry. The inclusion criteria for selecting patients to the study group was HbA1c of 9 gram/dL and higher. A comparison control study was designed to include T2DM patients similar in all characteristics except for HbA1c of 7.5 gram/dl and less. Results: We included 20 patients who underwent laparoscopic sleeve gastrectomy. Each group of patients included half of the patients. The mean pre operative HbA1c in the studied and the control group were 10.4 gram/dL and 7.1 gram/dL respectively (p<0.001). There were no differences in peri-operative morbidity and length of stay at the hospital. Mean excess weight loss, fasting glucose levels and HbA1c levels were similar six months post surgery mean. Conclusions: According to our study we have not found correlation between high HbA1c levels and increased peri-operative morbidity or insufficient excess weight loss among patients who underwent laparoscopic sleeve gastrectomy. [Copyright &y& Elsevier]