Carences nutritionnelles après sleeve gastrectomie et by-pass gastrique

Bariatric surgery represents today a therapeutic option of choice for severe and morbid obesity. Beyond its spectacular efficacy on weight reduction and comorbidities associated with obesity, bariatric surgery is associated with a significant risk of postoperative nutritional deficiencies, in protein, vitamins, minerals, and traces elements. In France, the most practiced operative procedure today is the sleeve gastrectomy, followed by the gastric bypass. The sleeve gastrectomy has gained popularity in recent years in part because it is deemed less provider of nutritional deficiencies than the gastric bypass, but the reality is more nuanced and, overall, the risk of deficiencies is comparable after the two types of interventions at least during the first years. The postoperative nutritional deficiencies may appear early or late after surgery. Some of these deficiencies can have clinical consequences in the short, medium, or long term, that can be sometimes severe and are often overlooked. Schematically, postoperative nutritional deficiencies may be due to the interlinking of several mechanisms: high prevalence of preoperative deficiencies; reduction - sometimes drastic - of food intake after surgery; creation of conditions of malabsorption by the surgical procedure; inadequacy of and/or poor compliance to the micronutrient supplementation prescribed postoperatively. There is no intervention study that could permit to define precisely how to prescribe micronutrient supplementation after sleeve gastrectomy or after gastric bypass. The latest guidelines recommend routine supplementation with multivitamins and minerals, calcium, vitamin D, iron and vitamin B12 after sleeve gastrectomy as after gastric bypass (then adapted to clinical and biological evolution/. Anyway, it is essential to conduct a thorough nutritional assessment prior to bariatric surgery, to organize patient therapeutic education programs emphasizing the importance of taking the prescribed supplements and being regular monitored, and to formalize the postoperative follow-up in the short, medium, and long term, in order to prevent, detect and treat the protein malnutrition and the micronutrient deficiencies, and their potential clinical consequences.