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Various methods of gastric bypass or gastric restriction surgery are used to treat morbid obesity. Roux-en-Y gastric bypass surgery (RYGB) but not sleeve gastric bypass surgery or gastric banding, increases the risk of vitamin B 12 deficiency and requires preventive post-operative treatment with either injected or high-dose oral supplementation.
Gastric bypass is indicated for the surgical treatment of severe obesity, a diagnosis which is made when the patient is seriously obese, has been unable to achieve satisfactory and sustained weight loss by dietary efforts and has comorbid conditions that are either life-threatening or serious impairment to the quality of life.
Low serum levels of Vitamin B12, Vitamin A, Vitamin D, Vitamin E, and Vitamin K are common nutritional deficiencies after the surgery. 1000 mg of Vitamin B12 is recommended monthly, and supplements of vitamins and minerals are also recommended for the first half to full year after the surgery until the rapid weight loss period has passed. [2]
A single protocol is not superior to the other. In one 2019 systematic review, estimated weight loss (EWL) for each surgical protocol is as follows: 56.7% for gastric bypass, 45.9% for gastric banding, 74.1% for biliopancreatic bypass +/- duodenal switch and 58.3% for sleeve gastrectomy. [28]
Cyanocobalamin injections are often prescribed to gastric bypass patients who have had part of their small intestine bypassed, making it difficult for B 12 to be acquired via food or vitamins. Cyanocobalamin is also used to perform the Schilling test to check ability to absorb vitamin B 12. [16]
Gastric surgeries that involve the removal of all or part of the stomach, such as Roux-en-Y gastric bypass or surgical removal of the small bowel results in short bowel syndrome. [ 126 ] Digestive conditions: conditions that can give rise to impaired absorption of vitamin B 12 may include achlorhydria , Crohn's disease , coeliac disease ...
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