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    105: bariatric surgery and pregnancy.Obstet Gynecol.2009;113:14051413EL 4, position KominiarekMA.Pregnancy after bariatric surgery.Obstet Gynecol Clin North Am.2010;37:305320EL 4, review MagdalenoR, PereiraBG, ChaimEA, etal.Pregnancy after bariatric surgery: a current view of maternal, obstetrical and perinatal challenges.Arch Gynecol Obstet.2012;285:559566EL 4, review CathelineJM, BihanH, Le QuangT, etal.Preoperative cardiac and pulmonary assessment in bariatric surgery.Obes Surg.2008;18:271277EL 2, PCS Kwon S, Thompson R, Florence M, et alHigh-volume exercise program in obese bariatric surgery patients: a randomized, controlled trialEpub 2011 Jul 18.EL 3, SS MitchellJE, SteffenKJ.de Zwaan M, et alR71(R153156)General recommendations for the prevention and treatment of nutritional deficiencies.Diabetes Metab.2009;35:544557EL 4, NE consensus FariaSL.Dietary protein intake and bariatric surgery.Obes Surg.2011;21:17981805EL 4, NE review RaftopoulosI.Protein intake compliance with morbidly obese patients undergoing bariatric surgery and its effect on weight loss and biochemical parameters.Surg Obes Relat Dis.2011;7:733742EL 2, PCS Billy H, Okerson T.Changes in body composition following gastric bypass or gastric bandingThe risk of VTE was greater in the patients undergoing RYGB than in those undergoing adjustable gastric banding (.55% versus .16%)(188 [EL 3, SS])R30(NEW)All patients should undergo evaluation of their ability to incorporate nutritional and behavioral changes before and after bariatric surgery(Grade C; BEL 3)There are abnormalities in zinc (and iron) absorption markers following RYGB, reinforcing the need to monitor these analytes in this setting ([251],[253],[362])In a survey 610 years after RYGB, 7.1% of patients had alcohol abuse or dependence before surgery, which was unchanged postoperatively, whereas 2.9% admitted to alcohol dependence after surgery but not before surgery(215 [EL 3, SS])John BR12(18/19)-rPulmonary management includes aggressive pulmonary toilet and incentive spirometry, oxygen supplementation to avoid hypoxemia, and early institution of continuous positive airway pressure (CPAP) when clinically indicated (Grade C, BEL 3)41

     

    However, BMI is confounded by ethnic differences ([43],[44]) and body composition(44 [EL 4, NE]);(45 [EL 2, CSS], and future improved risk stratification strategies may incorporate other anthropometric measurements, such as waist circumference(46 [EL 3, SS])or waist-to-hip ratio(43 [EL 2, MNRCT]), co-morbidity and functional status assessments(47 [EL 4 NE]), and body composition technologies(45 [EL 3, CSS])Additionally, for patients who have T2D recurrence several years after surgery, the legacy effects of a remission period on their long-term cardiovascular risk is not known501, and includes the oiled road on Range Road 121 south of Burdett.For more information Click here2There are 74 recommendations in this 2013 update, compared with 164 original recommendations in 2008There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG (7 [EL 4, CPG])Obes Surg 2011;21:173949.EL 1, RCT (findings limited by generalizability and relevance of dysautonomia on overall outcomes) Shah M, Snell PG, Rao S, et alThe Michigan Bariatric Collaborative study (N=542 RYGB patients) found that prophylactic IVC filter placement was not associated with a decrease in VTE-related complications, serious complications, or death (OR=2.49; 95% CO .996.26)(304 [EL 3, SS])Patients who have undergone RYGB, BPD, or BPD/DS and who present with postprandial hypoglycemic symptoms that have not responded to nutritional manipulation should undergo an evaluation to differentiate noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) from factitious or iatrogenic causes, dumping syndrome, and insulinoma(Grade C; BEL 3).In patients with NIPHS, therapeutic strategies include dietary changes (low carbohydrate diet), octreotide, diazoxide, acarbose, calcium channel antagonists, gastric restriction, and reversal procedures, with partial or total pancreatectomy reserved for the rare recalcitrant cases(Grade C; BEL 3)How can optimal follow-up of bariatric surgery be achieved?Probiotics can reduce bacterial overgrowth and promote weight loss in RYGB patients(359 [EL 1, RCT])R49(101/102)Surg Obes Relat Dis Epub 2011 Aug 28.EL 3, SS TohSY, ZarshenasN, JorgensenJ.Prevalence of nutrient deficiencies in bariatric patients.Nutrition.2009;25:11501156EL 3, SS Alasfar F, Ben-Nakhi M, Khoursheed M, et alR52(108)This recommendation is consistent with the 2011 AACE DCCP CPG(153 [EL 4, CPG])Our co-packing suitesare climate controlled and segregated from each otherObes Surg 2011;21:16506.EL 1, RCT HimpensJ, DapriG, CadiereGB.A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years.Obes Surg.2006;16:14501456EL 1, RCT Lee WJ, Chong K, Ser KH, et alTherapeutic strategies to manage hyperoxalaturia in bariatric surgery patients include calcium supplementation, increased hydration, limiting dietary oxalate, and adhering with a low fat diet(356 [EL 2, PCS])A lifetime history of substance abuse disorder is more likely in bariatric surgery candidates compared with the general population(211 [EL 3, SS]) 19d25c4272

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