Common postoperative problems

In addition to nutrient deficiencies after bariatric surgery, there are other common side effects that are worth mentioning because they may be confused with symptoms of pregnancy.

  • Vomiting. Emesis may occur after surgery if the patient eats too much at one time, eats too quickly, or does not chew solid food thoroughly. Food that is not chewed well may get stuck in the narrow anastomosis between the stomach pouch and jejunum. Scarring and stricture may also narrow the outlet and lead to vomiting. Excessive vomiting in patients who have had the AGB requires removal of some saline from their band to reduce the degree of restriction [23]. It is important to correct the problem because persistent vomiting may lead to malnutrition and dehydration, which are harmful during pregnancy.
  • Constipation. Constipation may occur because postoperative patients focus on highprotein foods as a dietary mainstay and reduce their overall quantity of food intake, so their fiber intake may be suboptimal. If the patient is not drinking an adequate amount of fluid, then this may exacerbate the constipation. In addition, the iron that is recommended for bariatric patients and for pregnancy is also known to cause constipation. A stool softener or fiber supplement such as Metamucil┬« can be suggested.
  • Dumping syndrome. This occurs after RYGB when there is consumption of simple sugars. The patient may feel nauseated, and suffer tachycardia, syncope, and diarrhea. The syndrome may be averted by instructing patients to avoid concentrated sweets. Importantly, when screening for gestational diabetes mellitus (GDM) during pregnancy, a glucose tolerance test will likely cause dumping syndrome. An alternative approach to assess for GDM would involve measuring fasting serum glucose periodically, since an elevation usually correlates with elevated postprandial blood glucose [24]. The overall risk of GDM is significantly lower in bariatric patients than in morbidly obese women [25].

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