Mihmanli Mehmet, Isil Riza Gurhan, Isil Canan Tulay, Omeroglu Sinan, Sayin Pinar, Oba Sibel, Ozturk Feyza Yener, Altuntas Yuksel
General Surgery Clinic, Sisli Hamidiye Etfal Education and Research Hospital, Halaskargazi Cad. Etfal Sok., 34733, Sisli, Istanbul, Turkey.
Anesthesiology Clinic, Sisli Hamidiye Etfal Education and Research Hospital, Halaskargazi Cad. Etfal Sok., 34733, Sisli, Istanbul, Turkey.
Obes Surg. 2017 Dec;27(12):3149-3155. doi: 10.1007/s11695-017-2747-x.
Laparoscopic sleeve gastrectomy (LSG) reduces obesity-related co-morbidities, such as diabetes, hypertension, and hyperlipidemia. Endocrinological abnormalities may occur as undesired side effects. Most centers routinely prescribe folic acid, cyanocobalamin (vitB12), and protein replacement in the postoperative period, but 25-OH-vitamin-D3 (vitD) and intact parathyroid hormone (iPTH) levels are not routinely followed up. The aim of this study was to identify the effects of LSG on iPTH, vitD, calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and albumin levels.
Data of morbidly obese patients who underwent LSG between January and December 2014 were studied in this prospectively designed study. Serum levels of iPTH, vitD, Ca, P, folic acid, vitB12, ALP, and albumin were measured preoperatively and postoperatively at the 3rd, 6th, and 12th months.
In total, 119 patients were analyzed. All patients had normal iPTH, vitD, Ca, P, folic acid, vitB12, ALP, and albumin values preoperatively, and 31.6% had received vitD supplementation during their nutritionist observation time before surgery. At the 3rd, 6th, and 12th postoperative months, 21 (17.6%), 17 (17.3%), and 1 (0.8%) patients, respectively, had increased iPTH and ALP and decreased vitD levels. A total of 39 (32.7%) patients needed high-dose vitD treatment during a 1 year follow-up. Approximately 37.5% of the patients who received vitD supplementation preoperatively needed vitD supplementation postoperatively. Hospital records of 101 of 119 patients who underwent LSG could be screened to determine their vitD supplementation requirements previously ordered by their nutritionist for a 1-year period before LSG. Thirty-two (31.6%) of the 101 patients had received vitD supplementation during the 1-year period preoperatively.
Although serum levels of iPTH, vitD, Ca, P, vitB12, ALP, and albumin may be normal preoperatively, severe vitD insufficiency requiring high-dose vitD replacement may develop in morbidly obese patients postoperatively. Instead of iPTH and vitD, which are expensive to measure, ALP serum level, which is correlated with iPTH levels, can be a good indicator to monitor calcium metabolism.
腹腔镜袖状胃切除术（LSG）可降低肥胖相关的合并症，如糖尿病、高血压和高脂血症。内分泌异常可能作为不良副作用出现。大多数中心在术后常规开具叶酸、氰钴胺（维生素B12）和蛋白质补充剂，但25-羟基维生素D3（维生素D）和完整甲状旁腺激素（iPTH）水平并未常规随访。本研究的目的是确定LSG对iPTH、维生素D、钙（Ca）、磷（P）、碱性磷酸酶（ALP）和白蛋白水平的影响。
在这项前瞻性设计的研究中，对2014年1月至12月期间接受LSG的病态肥胖患者的数据进行了研究。术前及术后第3、6和12个月测量血清iPTH、维生素D、Ca、P、叶酸、维生素B12、ALP和白蛋白水平。
共分析了119例患者。所有患者术前iPTH、维生素D、Ca、P、叶酸、维生素B12、ALP和白蛋白值均正常，31.6%的患者在术前营养师观察期间接受过维生素D补充。术后第3、6和12个月，分别有21例（17.6%）、17例（17.3%）和1例（0.8%）患者iPTH和ALP升高，维生素D水平降低。在1年的随访期间，共有39例（32.7%）患者需要高剂量维生素D治疗。术前接受维生素D补充的患者中，约37.5%术后仍需要维生素D补充。对119例接受LSG的患者中的101例的医院记录进行筛查，以确定他们在LSG前1年营养师先前开具的维生素D补充需求。101例患者中有32例（31.6%）在术前1年期间接受过维生素D补充。
尽管术前血清iPTH、维生素D、Ca、P、维生素B12、ALP和白蛋白水平可能正常，但病态肥胖患者术后可能会出现需要高剂量维生素D替代的严重维生素D缺乏。与iPTH水平相关的ALP血清水平，而非昂贵的iPTH和维生素D，可作为监测钙代谢的良好指标。
