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Perioperative Care of the Surgical Patient

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The Clinician’s Guide to the Treatment of Obesity

Part of the book series: Endocrine Updates ((ENDO))

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Abstract

The prevalence of obesity has been increasing in adults over the past 30 years. Treatment of obesity includes behavioral modification, pharmacotherapy, and bariatric surgery. By far, bariatric surgery is the most effective treatment for severe obesity and can reduce mortality and obesity-related comorbid conditions in severely obese patients. There has been an increase in the number of bariatric surgery performed since the introduction of minimally invasive surgery and estimated about 113,000 cases undergoing bariatric surgery per year. The goal of perioperative care and evaluation is to ensure proper candidate selection, reduce surgical risks, and optimize postoperative outcomes. In this chapter, we discuss the preoperative evaluation for obesity-related comorbidities and baseline nutrient screening, immediate postoperative management, and long-term care including management of patients’ comorbidities, recognition of complications, nutritional supplements, and monitoring.

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References

  1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307(5):491–7. Epub 2012/01/19.

    Article  PubMed  Google Scholar 

  2. Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean AP, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416–23. discussion 23–4. Epub 2004/08/21.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sjostrom L . Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes (Lond). 2008;32(Suppl 7):93–7. Epub 2009/01/16.

    Article  Google Scholar 

  4. Livingston EH. The incidence of bariatric surgery has plateaued in the U.S. Am J Surg. 2010;200(3):378–85. Epub 2010/04/23.

    Article  PubMed  PubMed Central  Google Scholar 

  5. NIH conference. Gastrointestinal surgery for severe obesity. Consensus development conference panel. Ann Intern Med. 1991;115(12):956–61. Epub 1991/12/15.

    Article  Google Scholar 

  6. SAGES. Guideline for clinical application of laparoscopic bariatric surgery. Surg Endosc. 2008;22(10):2281–300. Epub 2008/09/16.

    Article  Google Scholar 

  7. Harper J, Madan AK, Ternovits CA, Tichansky DS. What happens to patients who do not follow-up after bariatric surgery? Am Surg. 2007;73(2):181–4. Epub 2007/02/20.

    PubMed  Google Scholar 

  8. Shen R, Dugay G, Rajaram K, Cabrera I, Siegel N, Ren CJ. Impact of patient follow-up on weight loss after bariatric surgery. Obes Surg. 2004;14(4):514–9. Epub 2004/05/08.

    Article  PubMed  Google Scholar 

  9. Moulin de Moraes CM, Mancini MC, de Melo ME, Figueiredo DA, Villares SM, Rascovski A, et al. Prevalence of subclinical hypothyroidism in a morbidly obese population and improvement after weight loss induced by Roux-en-Y gastric bypass. Obes Surg. 2005;15(9):1287–91. Epub 2005/11/02.

    Article  PubMed  Google Scholar 

  10. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2012;18(6):988–1028. Epub 2012/12/19.

    Google Scholar 

  11. Jankovic D, Wolf P, Anderwald CH, Winhofer Y, Promintzer-Schifferl M, Hofer A, et al. Prevalence of endocrine disorders in morbidly obese patients and the effects of bariatric surgery on endocrine and metabolic parameters. Obes Surg. 2012;22(1):62–9. Epub 2011/11/05.

    Article  PubMed  Google Scholar 

  12. Baid SK, Rubino D, Sinaii N, Ramsey S, Frank A, Nieman LK. Specificity of screening tests for Cushing’s syndrome in an overweight and obese population. J Clin Endocrinol Metab. 2009;94(10):3857–64. Epub 2009/07/16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Sahin SB, Sezgin H, Ayaz T, Uslu Gur E, Ilkkilic K. Routine Screening for Cushing’s syndrome is not required in patients presenting with obesity. ISRN Endocrinol. 2013;2013:321063. Epub 2013/07/11.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ness-Abramof R, Nabriski D, Apovian CM, Niven M, Weiss E, Shapiro MS, et al. Overnight dexamethasone suppression test: a reliable screen for Cushing’s syndrome in the obese. Obes Res. 2002;10(12):1217–21. Epub 2002/12/20.

    Article  CAS  PubMed  Google Scholar 

  15. Bray GA. Medical consequences of obesity. J Clin Endocrinol Metab. 2004;89(6):2583–9. Epub 2004/06/08.

    Article  CAS  PubMed  Google Scholar 

  16. Tavares Ida S, Sousa AC, Menezes Filho RS, Aguiar-Oliveira MH, Barreto-Filho JA, Brito AF, et al. Left ventricular diastolic function in morbidly obese patients in the preoperative for bariatric surgery. Arq Bras de Cardiol. 2012;98(4):300–6. Epub 2012/03/28.

    Article  Google Scholar 

  17. Kwon S, Thompson R, Florence M, Maier R, McIntyre L, Rogers T, et al. Beta-blocker continuation after noncardiac surgery: a report from the surgical care and outcomes assessment program. Arch Surg. 2012;147(5):467–73. Epub 2012/01/18.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Auerbach A, Goldman L. Assessing and reducing the cardiac risk of noncardiac surgery. Circulation. 2006;113(10):1361–76. Epub 2006/03/15.

    Article  PubMed  Google Scholar 

  19. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21(Suppl 1):1–27. Epub 2013/04/03.

    Article  CAS  Google Scholar 

  20. Daltro C, Gregorio PB, Alves E, Abreu M, Bomfim D, Chicourel MH, et al. Prevalence and severity of sleep apnea in a group of morbidly obese patients. Obes Surg. 2007;17(6):809–14. Epub 2007/09/21.

    Article  PubMed  Google Scholar 

  21. Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54. Epub 2009/07/31.

    Article  PubMed  Google Scholar 

  22. Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008;31(8):1079–85. Epub 2008/08/22.

    PubMed  PubMed Central  Google Scholar 

  23. Ge X, Han F, Huang Y, Zhang Y, Yang T, Bai C, et al. Is obstructive sleep apnea associated with cardiovascular and all-cause mortality? PloS ONE. 2013;8(7):e69432. Epub 2013/08/13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Abbas Q, Arjomand F, Kumar M, Contreras J, Shahzad S, Jinnur P, Ahmad M, Tiwary T, Ali Rana, Vasudevan P. Occlusive Sleep Apnea (OSA) Screening and Preemptive Continuous Positive Airway Pressure (CPAP)/Bilevel Positive Airway Pressure (BiPAP) Application is effective in reducing post bariatric surgery pulmonary complications. Chest. 10/24/122012. p 1065A.

    Google Scholar 

  25. Sanyal AJ. AGA technical review on nonalcoholic fatty liver disease. Gastroenterology. 2002;123(5):1705–25. Epub 2002/10/31.

    Article  PubMed  Google Scholar 

  26. Wu J, You J, Yerian L, Shiba A, Schauer PR, Sessler DI. Prevalence of liver steatosis and fibrosis and the diagnostic accuracy of ultrasound in bariatric surgery patients. Obes Surg. 2012;22(2):240–7. Epub 2011/09/09.

    Article  PubMed  Google Scholar 

  27. Malfertheiner P, Megraud F, O’Morain CA, Atherton J, Axon AT, Bazzoli F, et al. Management of Helicobacter pylori infection–the Maastricht IV/Florence Consensus Report. Gut. 2012;61(5):646–64. Epub 2012/04/12.

    Article  CAS  PubMed  Google Scholar 

  28. Hartin CW, Jr., ReMine DS, Lucktong TA. Preoperative bariatric screening and treatment of Helicobacter pylori. Surg Endosc. 2009;23(11):2531–4. Epub 2009/05/16.

    Article  PubMed  Google Scholar 

  29. Schirmer B, Erenoglu C, Miller A. Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass. Obes Surg. 2002;12(5):634–8. Epub 2002/11/27.

    Article  PubMed  Google Scholar 

  30. Ogunnaike BO, Jones SB, Jones DB, Provost D, Whitten CW. Anesthetic considerations for bariatric surgery. Anesth Analg. 2002;95(6):1793–805. Epub 2002/11/29.

    Article  PubMed  Google Scholar 

  31. Birkmeyer NJ, Share D, Baser O, Carlin AM, Finks JF, Pesta CM, et al. Preoperative placement of inferior vena cava filters and outcomes after gastric bypass surgery. Ann Surg. 2010;252(2):313–8. Epub 2010/07/14.

    Article  PubMed  Google Scholar 

  32. Keeling WB, Haines K, Stone PA, Armstrong PA, Murr MM, Shames ML. Current indications for preoperative inferior vena cava filter insertion in patients undergoing surgery for morbid obesity. Obes Surg. 2005;15(7):1009–12. Epub 2005/08/18.

    Article  PubMed  Google Scholar 

  33. Atluri P, Raper SE. Factor V Leiden and postoperative deep vein thrombosis in patients undergoing open Roux-en-Y gastric bypass surgery. Obesity Surg. 2005;15(4):561–4. Epub 2005/06/11.

    Article  Google Scholar 

  34. Vilarrasa N, San Jose P, Garcia I, Gomez-Vaquero C, Miras PM, de Gordejuela AG, et al. Evaluation of bone mineral density loss in morbidly obese women after gastric bypass: 3-year follow-up. Obes Surg. 2011;21(4):465–72. Epub 2010/12/29.

    Article  PubMed  Google Scholar 

  35. Stein EM, Carrelli A, Young P, Bucovsky M, Zhang C, Schrope B, et al. Bariatric surgery results in cortical bone loss. J Clin Endocrinol Metab. 2013;98(2):541–9. Epub 2013/01/09.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Miller PD. Guidelines for the diagnosis of osteoporosis: T-scores vs fractures. Rev Endocr Metab disord. 2006;7(1–2):75–89. Epub 2006/12/23.

    PubMed  Google Scholar 

  37. Fullmer MA, Abrams SH, Hrovat K, Mooney L, Scheimann AO, Hillman JB, et al. Nutritional strategy for adolescents undergoing bariatric surgery: report of a working group of the Nutrition Committee of NASPGHAN/NACHRI. J Pediatr Gastroenterol Nutr. 2012;54(1):125–35. Epub 2011/08/23.

    Article  PubMed  Google Scholar 

  38. Brolin RE. Gastric bypass. Surg Clin North Am. 2001;81(5):1077–95. Epub 2001/10/09.

    Article  CAS  PubMed  Google Scholar 

  39. Goldner WS, Stoner JA, Thompson J, Taylor K, Larson L, Erickson J, et al. Prevalence of vitamin D insufficiency and deficiency in morbidly obese patients: a comparison with non-obese controls. Obesity Surg. 2008;18(2):145–50. Epub 2008/01/05.

    Article  Google Scholar 

  40. Sarwer DB, Cohn NI, Gibbons LM, Magee L, Crerand CE, Raper SE, et al. Psychiatric diagnoses and psychiatric treatment among bariatric surgery candidates. Obesity Surg. 2004;14(9):1148–56. Epub 2004/11/06.

    Article  Google Scholar 

  41. Kinzl JF, Maier C, Bosch A. [Morbidly obese patients: psychopathology and eating disorders—Results of a preoperative evaluation]. Neuropsychiatr (Klinik, Diagnostik, Therapie und Rehabilitation: Organ der Gesellschaft Osterreichischer Nervenarzte und Psychiater). 2012;26(4):159–65. Epub 2012/11/28. Morbid adipose Patienten: Psychopathologie und Essstorungen: Ergebnisse einer praoperativen Evaluation.

    Article  PubMed  Google Scholar 

  42. Klockhoff H, Naslund I, Jones AW. Faster absorption of ethanol and higher peak concentration in women after gastric bypass surgery. Br J Clin Pharmacol. 2002;54(6):587–91. Epub 2002/12/21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Maluenda F, Csendes A, De Aretxabala X, Poniachik J, Salvo K, Delgado I, et al. Alcohol absorption modification after a laparoscopic sleeve gastrectomy due to obesity. Obesity Surg. 2010;20(6):744–8. Epub 2010/04/02.

    Article  Google Scholar 

  44. Heinberg LJ, Ashton K, Coughlin J. Alcohol and bariatric surgery: review and suggested recommendations for assessment and management. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2012;8(3):357–63. Epub 2012/03/20.

    Article  Google Scholar 

  45. Kudsi OY, Huskey K, Grove S, Blackburn G, Jones DB, Wee CC. Prevalence of preoperative alcohol abuse among patients seeking weight-loss surgery. Surgical Endosc. 2013;27(4):1093–7. Epub 2012/10/12.

    Article  Google Scholar 

  46. Felix EL, Kettelle J, Mobley E, Swartz D. Perforated marginal ulcers after laparoscopic gastric bypass. Surg Endosc. 2008;22(10):2128–32. Epub 2008/06/17.

    Article  PubMed  Google Scholar 

  47. Carroll KK. Obesity as a risk factor for certain types of cancer. Lipids. 1998;33(11):1055–9. Epub 1998/12/31.

    Article  CAS  PubMed  Google Scholar 

  48. Bergstrom A, Pisani P, Tenet V, Wolk A, Adami HO. Overweight as an avoidable cause of cancer in Europe. Int J Cancer. 2001;91(3):421–30. Epub 2001/02/15.

    Article  CAS  PubMed  Google Scholar 

  49. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348(17):1625–38. Epub 2003/04/25.

    Article  PubMed  Google Scholar 

  50. Griffith DP, Liff DA, Ziegler TR, Esper GJ, Winton EF. Acquired copper deficiency: a potentially serious and preventable complication following gastric bypass surgery. Obesity (Silver Spring). 2009;17(4):827–31. Epub 2009/01/17.

    Article  CAS  Google Scholar 

  51. Deitel M, Stone E, Kassam HA, Wilk EJ, Sutherland DJ. Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery. J Am Coll Nutr. 1988;7(2):147–53. Epub 1988/04/01.

    Article  CAS  PubMed  Google Scholar 

  52. Marceau P, Kaufman D, Biron S, Hould FS, Lebel S, Marceau S, et al. Outcome of pregnancies after biliopancreatic diversion. Obes Surg. 2004;14(3):318–24. Epub 2004/04/10.

    Article  PubMed  Google Scholar 

  53. Magdaleno R, Jr., Pereira BG, Chaim EA, Turato ER. Pregnancy after bariatric surgery: a current view of maternal, obstetrical and perinatal challenges. Arch Gynecol Obstet. 2012;285(3):559–66. Epub 2011/12/30.

    Article  PubMed  Google Scholar 

  54. Fris RJ. Preoperative low energy diet diminishes liver size. Obes Surg. 2004;14(9):1165–70. Epub 2004/11/06.

    Article  PubMed  Google Scholar 

  55. Alvarado R, Alami RS, Hsu G, Safadi BY, Sanchez BR, Morton JM, et al. The impact of preoperative weight loss in patients undergoing laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2005;15(9):1282–6. Epub 2005/11/02.

    Article  CAS  PubMed  Google Scholar 

  56. Edholm D, Kullberg J, Haenni A, Karlsson FA, Ahlstrom A, Hedberg J, et al. Preoperative 4-week low-calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obes Surg. 2011;21(3):345–50. Epub 2010/12/25.

    Article  PubMed  Google Scholar 

  57. Alami RS, Morton JM, Schuster R, Lie J, Sanchez BR, Peters A, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Rel Dis Off J Am Soc Bariatr Surg. 2007;3(2):141–5; discussion 5–6. Epub 2007/03/03.

    Google Scholar 

  58. Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, et al. Does weight loss immediately before bariatric surgery improve outcomes: a systematic review. Surg Obes Rel Dis Off J Am Soc Bariatr Surg. 2009;5(6):713–21. Epub 2009/11/03.

    Google Scholar 

  59. Becouarn G, Topart P, Ritz P. Weight loss prior to bariatric surgery is not a pre-requisite of excess weight loss outcomes in obese patients. Obes Surg. 2010;20(5):574–7. Epub 2010/02/23.

    Article  PubMed  Google Scholar 

  60. Cassie S, Menezes C, Birch DW, Shi X, Karmali S. Effect of preoperative weight loss in bariatric surgical patients: a systematic review. Surg Obes Rel Dis Off J Am Soc Bariatr Surg. 2011;7(6):760–7; discussion 7. Epub 2011/10/08.

    Google Scholar 

  61. American Diabetes Association. Standards of medical care in diabetes–2013. Diabetes Care. 2013;36(Suppl 1):11–66. Epub 2013/01/04.

    Article  CAS  Google Scholar 

  62. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes care. 2012;35(6):1364–79. Epub 2012/04/21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Perna M, Romagnuolo J, Morgan K, Byrne TK, Baker M. Preoperative hemoglobin A1c and postoperative glucose control in outcomes after gastric bypass for obesity. Surg Obes Rel Dis Off J Am Soc Bariatr Surg. 2012;8(6):685–90. Epub 2011/10/11.

    Google Scholar 

  64. Pomposelli JJ, Baxter JK, 3rd, Babineau TJ, Pomfret EA, Driscoll DF, Forse RA, et al. Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. JPEN J Parenter Enteral Nutr. 1998;22(2):77–81. Epub 1998/04/07.

    Article  CAS  PubMed  Google Scholar 

  65. Ata A, Lee J, Bestle SL, Desemone J, Stain SC. Postoperative hyperglycemia and surgical site infection in general surgery patients. Arch Surg. 2010;145(9):858–64. Epub 2010/09/22.

    Article  PubMed  Google Scholar 

  66. Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59. Epub 2005/04/06.

    Article  PubMed  Google Scholar 

  67. DeMaria EJ, Pate V, Warthen M, Winegar DA. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database. Surg Obes Rel Dis Off J Am Soc Bariatr Surg. 2010;6(4):347–55. Epub 2010/02/24.

    Google Scholar 

  68. Livingston EH. Procedure incidence and in-hospital complication rates of bariatric surgery in the United States. Am J Surg. 2004;188(2):105–10. Epub 2004/07/14.

    Article  PubMed  Google Scholar 

  69. Levi D, Goodman ER, Patel M, Savransky Y. Critical care of the obese and bariatric surgical patient. Crit Care Clin. 2003;19(1):11–32. Epub 2003/04/12.

    Article  PubMed  Google Scholar 

  70. Mukherjee D, Eagle KA. Perioperative cardiac assessment for noncardiac surgery: eight steps to the best possible outcome. Circulation. 2003;107(22):2771–4. Epub 2003/06/11.

    Article  PubMed  Google Scholar 

  71. Sapala JA, Wood MH, Schuhknecht MP, Sapala MA. Fatal pulmonary embolism after bariatric operations for morbid obesity: a 24-year retrospective analysis. Obes Surg. 2003;13(6):819–25. Epub 2004/01/24.

    Article  PubMed  Google Scholar 

  72. Magee CJ, Barry J, Javed S, Macadam R, Kerrigan D. Extended thromboprophylaxis reduces incidence of postoperative venous thromboembolism in laparoscopic bariatric surgery. Surg Obes Rel Dis Off J Am Soc Bariatr Surg. 2010;6(3):322–5. Epub 2010/06/01.

    Google Scholar 

  73. Raftopoulos I, Martindale C, Cronin A, Steinberg J. The effect of extended post-discharge chemical thromboprophylaxis on venous thromboembolism rates after bariatric surgery: a prospective comparison trial. Surg Endosc. 2008;22(11):2384–91. Epub 2008/07/16.

    Article  PubMed  Google Scholar 

  74. Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003;138(9):957–61. Epub 2003/09/10.

    Article  PubMed  Google Scholar 

  75. Lawrence VA, Cornell JE, Smetana GW. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144(8):596–608. Epub 2006/04/19.

    Article  PubMed  Google Scholar 

  76. Ramirez A, Lalor PF, Szomstein S, Rosenthal RJ. Continuous positive airway pressure in immediate postoperative period after laparoscopic Roux-en-Y gastric bypass: is it safe? Surg Obes Relat Dis. 2009;5(5):544–6. Epub 2009/07/31.

    Article  PubMed  Google Scholar 

  77. Chiumello D, Chevallard G, Gregoretti C. Non-invasive ventilation in postoperative patients: a systematic review. Intensive Care Med. 2011;37(6):918–29. Epub 2011/03/23.

    Article  CAS  PubMed  Google Scholar 

  78. Hamilton EC, Sims TL, Hamilton TT, Mullican MA, Jones DB, Provost DA. Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2003;17(5):679–84. Epub 2003/03/06.

    Article  CAS  PubMed  Google Scholar 

  79. Bellorin O, Abdemur A, Sucandy I, Szomstein S, Rosenthal RJ. Understanding the significance, reasons and patterns of abnormal vital signs after gastric bypass for morbid obesity. Obes Surg. 2011;21(6):707–13. Epub 2010/06/29.

    Article  PubMed  Google Scholar 

  80. Griffith PS, Birch DW, Sharma AM, Karmali S. Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity. Can J Surg (J Can de Chir). 2012;55(5):329–36. Epub 2012/08/03.

    Article  CAS  Google Scholar 

  81. Lagandre S, Arnalsteen L, Vallet B, Robin E, Jany T, Onraed B, et al. Predictive factors for rhabdomyolysis after bariatric surgery. Obes Surg. 2006;16(10):1365–70. Epub 2006/10/25.

    Article  CAS  PubMed  Google Scholar 

  82. de Oliveira LD, Diniz MT de Fatima HSDM, Savassi-Rocha AL, Camargos ST, Cardoso F. Rhabdomyolysis after bariatric surgery by Roux-en-Y gastric bypass: a prospective study. Obes Surg. 2009;19(8):1102–7. Epub 2008/12/20.

    Article  PubMed  Google Scholar 

  83. Chakravartty S, Sarma DR, Patel AG. Rhabdomyolysis in bariatric surgery: a systematic review. Obes Surg. 2013;23(8):1333–40. Epub 2013/04/09.

    Article  PubMed  Google Scholar 

  84. Wool DB, Lemmens HJ, Brodsky JB, Solomon H, Chong KP, Morton JM. Intraoperative fluid replacement and postoperative creatine phosphokinase levels in laparoscopic bariatric patients. Obes Surg. 2010;20(6):698–701. Epub 2010/03/04.

    Article  PubMed  Google Scholar 

  85. Shabanzadeh DM, Sorensen LT. Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients: a systematic review and meta-analysis. Ann Surg. 2012;256(6):934–45. Epub 2012/10/31.

    Article  PubMed  Google Scholar 

  86. Ruiz-Tovar J, Oller I, Llavero C, Arroyo A, Munoz JL, Calero A, et al. Pre-operative and early post-operative factors associated with surgical site infection after laparoscopic sleeve gastrectomy. Surg Infect. 2013;14(4):369–73. Epub 2013/05/31.

    Article  Google Scholar 

  87. Faria SL, Faria OP, Buffington C, de Almeida Cardeal M, Ito MK. Dietary protein intake and bariatric surgery patients: a review. Obes Surg. 2011;21(11):1798–805. Epub 2011/05/19.

    Article  PubMed  Google Scholar 

  88. Raftopoulos I, Bernstein B, O’Hara K, Ruby JA, Chhatrala R, Carty J. Protein intake compliance of morbidly obese patients undergoing bariatric surgery and its effect on weight loss and biochemical parameters. Surg Obes Relat Dis. 2011;7(6):733–42. Epub 2011/09/20.

    Article  PubMed  Google Scholar 

  89. Moize VL, Pi-Sunyer X, Mochari H, Vidal J. Nutritional pyramid for post-gastric bypass patients. Obes Surg. 2010;20(8):1133–41. Epub 2010/04/20.

    Article  PubMed  Google Scholar 

  90. Malone M. Recommended nutritional supplements for bariatric surgery patients. Ann Pharmacother. 2008;42(12):1851–8. Epub 2008/11/20.

    Article  CAS  PubMed  Google Scholar 

  91. Provenzale D, Reinhold RB, Golner B, Irwin V, Dallal GE, Papathanasopoulos N, et al. Evidence for diminished B12 absorption after gastric bypass: oral supplementation does not prevent low plasma B12 levels in bypass patients. J Am Coll Nutr. 1992;11(1):29–35. Epub 1992/02/01.

    Google Scholar 

  92. Aarts EO, van Wageningen B, Janssen IM, Berends FJ. Prevalence of anemia and related deficiencies in the first year following laparoscopic gastric bypass for morbid obesity. J Obes. 2012;2012:193705. Epub 2012/04/24.

    Google Scholar 

  93. Rhode BM, Arseneau P, Cooper BA, Katz M, Gilfix BM, MacLean LD. Vitamin B–12 deficiency after gastric surgery for obesity. Am J Clin Nutr. 1996;63(1):103–9. Epub 1996/01/01.

    Google Scholar 

  94. Brolin RE, Gorman JH, Gorman RC, Petschenik AJ, Bradley LJ, Kenler HA, et al. Are vitamin B12 and folate deficiency clinically important after roux-en-Y gastric bypass? J Gastrointest Surg. 1998;2(5):436–42. Epub 1998/12/08.

    Google Scholar 

  95. Brolin RE, Gorman JH, Gorman RC, Petschenik AJ, Bradley LB, Kenler HA, et al. Prophylactic iron supplementation after Roux-en-Y gastric bypass: a prospective, double-blind, randomized study. Arch Surg. 1998;133(7):740–4. Epub 1998/08/04.

    Google Scholar 

  96. Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(1):16–38. Epub 2012/01/10.

    Google Scholar 

  97. Aberle J, Reining F, Dannheim V, Flitsch J, Klinge A, Mann O. Metformin after bariatric surgery—an acid problem. Exp Clin Endocrinol Diabetes (Off J Ger Soc Endocrinol [and] Ger Diabetes Asso). 2012;120(3):152–3. Epub 2011/09/15.

    Google Scholar 

  98. Padwal RS, Gabr RQ, Sharma AM, Langkaas LA, Birch DW, Karmali S, et al. Effect of gastric bypass surgery on the absorption and bioavailability of metformin. Diabetes Care. 2011;34(6):1295–300. Epub 2011/04/12.

    Google Scholar 

  99. Still CD, Wood GC, Benotti P, Petrick AT, Gabrielsen J, Strodel WE, et al. Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study. Lancet Diabetes Endocrinol. 2013.

    Google Scholar 

  100. Houston MC. Abrupt cessation of treatment in hypertension: consideration of clinical features, mechanisms, prevention and management of the discontinuation syndrome. Am Heart J. 1981;102(3 Pt 1):415–30. Epub 1981/09/01.

    Article  CAS  PubMed  Google Scholar 

  101. Pischon T, Sharma AM. Use of beta-blockers in obesity hypertension: potential role of weight gain. Obes Rev. 2001;2(4):275–80. Epub 2002/07/18.

    Google Scholar 

  102. Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C. Endocrine and nutritional management of the post-bariatric surgery patient: an endocrine society clinical practice guideline. J Clin Endocrinol Metabol. 2010;95(11):4823–43. Epub 2010/11/06.

    Google Scholar 

  103. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59. Epub 2011/06/23.

    Google Scholar 

  104. Guyatt GH, Oxman AD, Ali M, Willan A, McIlroy W, Patterson C. Laboratory diagnosis of iron-deficiency anemia: an overview. J Gen Intern Med. 1992;7(2):145–53. Epub 1992/03/01.

    Google Scholar 

  105. Sumner AE, Chin MM, Abrahm JL, Berry GT, Gracely EJ, Allen RH, et al. Elevated methylmalonic acid and total homocysteine levels show high prevalence of vitamin B12 deficiency after gastric surgery. Ann Intern Med. 1996;124(5):469–76. Epub 1996/03/01.

    Google Scholar 

  106. Chaves LC, Faintuch J, Kahwage S, Alencar Fde A. A cluster of polyneuropathy and Wernicke-Korsakoff syndrome in a bariatric unit. Obes Surg. 2002;12(3):328–34. Epub 2002/06/27.

    Google Scholar 

  107. Saltzman E, Philip Karl J. Nutrient deficiencies after gastric bypass surgery. Annu Rev Nutr. 2013;33:183–203. Epub 2013/05/07.

    Google Scholar 

  108. Sechi G. Prognosis and therapy of Wernicke’s encephalopathy after obesity surgery. Am J Gastroenterol. 2008;103(12):3219. Epub 2008/12/18.

    Google Scholar 

  109. Fleischer J, Stein EM, Bessler M, Della Badia M, Restuccia N, Olivero-Rivera L, et al. The decline in hip bone density after gastric bypass surgery is associated with extent of weight loss. J Clin Endocrinol Metab. 2008;93(10):3735–40. Epub 2008/07/24.

    Google Scholar 

  110. King JC, Shames DM, Woodhouse LR. Zinc homeostasis in humans. J Nutr. 2000;130(5S Suppl):1360S–6S. Epub 2000/05/10.

    CAS  PubMed  Google Scholar 

  111. Salle A, Demarsy D, Poirier AL, Lelievre B, Topart P, Guilloteau G, et al. Zinc deficiency: a frequent and underestimated complication after bariatric surgery. Obes Surg. 2010;20(12):1660–70. Epub 2010/08/14.

    Article  PubMed  Google Scholar 

  112. Gasteyger C, Suter M, Gaillard RC, Giusti V. Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008;87(5):1128–33. Epub 2008/05/13.

    CAS  PubMed  Google Scholar 

  113. Gletsu-Miller N, Broderius M, Frediani JK, Zhao VM, Griffith DP, Davis SS, Jr., et al. Incidence and prevalence of copper deficiency following roux-en-y gastric bypass surgery. Int J Obes (Lond). 2012;36(3):328–35. Epub 2011/08/31.

    Article  CAS  Google Scholar 

  114. Ruz M, Carrasco F, Rojas P, Codoceo J, Inostroza J, Basfi-fer K, et al. Zinc absorption and zinc status are reduced after Roux-en-Y gastric bypass: a randomized study using 2 supplements. Am J Clin Nutr. 2011;94(4):1004–11. Epub 2011/08/26.

    Article  CAS  PubMed  Google Scholar 

  115. Jimenez A, Casamitjana R, Flores L, Viaplana J, Corcelles R, Lacy A, et al. Long-term effects of sleeve gastrectomy and Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus in morbidly obese subjects. Ann Surg. 2012;256(6):1023–9. Epub 2012/09/13.

    Article  PubMed  Google Scholar 

  116. Scott WR, Batterham RL. Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: understanding weight loss and improvements in type 2 diabetes after bariatric surgery. Am J Physiol Reg Integr Comp Physiol. 2011;301(1):R15–27. Epub 2011/04/09.

    Article  CAS  Google Scholar 

  117. Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93. Epub 2004/12/24.

    Article  PubMed  Google Scholar 

  118. Ahmed AR, Rickards G, Coniglio D, Xia Y, Johnson J, Boss T, et al. Laparoscopic Roux-en-Y gastric bypass and its early effect on blood pressure. Obes Surg. 2009;19(7):845–9. Epub 2008/09/02.

    Article  PubMed  Google Scholar 

  119. Nguyen NT, Varela E, Sabio A, Tran CL, Stamos M, Wilson SE. Resolution of hyperlipidemia after laparoscopic Roux-en-Y gastric bypass. J Am Coll Surg. 2006;203(1):24–9. Epub 2006/06/27.

    Article  PubMed  Google Scholar 

  120. Brolin RE, Bradley LJ, Wilson AC, Cody RP. Lipid risk profile and weight stability after gastric restrictive operations for morbid obesity. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2000;4(5):464–9. Epub 2000/11/15.

    Article  CAS  Google Scholar 

  121. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt):2889–934.

    Google Scholar 

  122. Shaffer EA. Bariatric surgery: a promising solution for nonalcoholic steatohepatitis in the very obese. J Clin Gastroenterol. 2006;40(Suppl 1):44–50. Epub 2006/03/17.

    Article  Google Scholar 

  123. Furuya CK, Jr., de Oliveira CP, de Mello ES, Faintuch J, Raskovski A, Matsuda M, et al. Effects of bariatric surgery on nonalcoholic fatty liver disease: preliminary findings after 2 years. J Gastroenterol Hepatol. 2007;22(4):510–4. Epub 2007/03/23.

    Article  CAS  PubMed  Google Scholar 

  124. Hafeez S, Ahmed MH. Bariatric surgery as potential treatment for nonalcoholic fatty liver disease: a future treatment by choice or by chance? J Obes. 2013;2013:839275. Epub 2013/02/23.

    Article  PubMed  PubMed Central  Google Scholar 

  125. Sarkhosh K, Switzer NJ, El-Hadi M, Birch DW, Shi X, Karmali S. The impact of bariatric surgery on obstructive sleep apnea: a systematic review. Obes Surg. 2013;23(3):414–23. Epub 2013/01/10.

    Article  PubMed  Google Scholar 

  126. Ravesloot MJ, Hilgevoord AA, van Wagensveld BA, de Vries N. Assessment of the effect of bariatric surgery on obstructive sleep apnea at two postoperative intervals. Obes Surg. 2013. Epub 2013/07/17.

    Google Scholar 

  127. Sawaya RA, Jaffe J, Friedenberg L, Friedenberg FK. Vitamin, mineral, and drug absorption following bariatric surgery. Curr Drug Metab. 2012;13(9):1345–55. Epub 2012/07/04.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  128. Santini F, Pinchera A, Marsili A, Ceccarini G, Castagna MG, Valeriano R, et al. Lean body mass is a major determinant of levothyroxine dosage in the treatment of thyroid diseases. J Clin Endocrinol Metab. 2005;90(1):124–7. Epub 2004/10/16.

    Article  CAS  PubMed  Google Scholar 

  129. Mallory GN, Macgregor AM, R and CS. The influence of dumping on weight loss after gastric restrictive surgery for morbid obesity. Obes Surg. 1996;6(6):474–8. Epub 1996/12/01.

    Article  CAS  PubMed  Google Scholar 

  130. Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract Off Publ Am Soc Parenter Enter Nutr. 2005;20(5):517–25. Epub 2005/10/07.

    Google Scholar 

  131. Service GJ, Thompson GB, Service FJ, Andrews JC, Collazo-Clavell ML, Lloyd RV. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med. 2005;353(3):249–54. Epub 2005/07/22.

    Article  CAS  PubMed  Google Scholar 

  132. Ceppa EP, Ceppa DP, Omotosho PA, Dickerson JA, 2nd, Park CW, Portenier DD. Algorithm to diagnose etiology of hypoglycemia after Roux-en-Y gastric bypass for morbid obesity: case series and review of the literature. Surg Obes Relat Dis. 2012;8(5):641–7. Epub 2011/10/11. (official journal of the American Society for Bariatric Surgery)

    Article  PubMed  Google Scholar 

  133. Machado JD, Campos CS, Lopes Dah Silva C, Marques Suen VM, Barbosa Nonino-Borges C, Dos Santos JE, et al. Intestinal bacterial overgrowth after Roux-en-Y gastric bypass. Obes Surg. 2008;18(1):139–43. Epub 2007/12/18.

    Article  PubMed  Google Scholar 

  134. Lakhani SV, Shah HN, Alexander K, Finelli FC, Kirkpatrick JR, Koch TR. Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients. Nutr Res. 2008;28(5):293–8. Epub 2008/12/17.

    Article  CAS  PubMed  Google Scholar 

  135. Woodard GA, Encarnacion B, Downey JR, Peraza J, Chong K, Hernandez-Boussard T, et al. Probiotics improve outcomes after Roux-en-Y gastric bypass surgery: a prospective randomized trial. J Gastrointest Surg. 2009;13(7):1198–204. Epub 2009/04/22 (official journal of the Society for Surgery of the Alimentary Tract).

    Article  PubMed  Google Scholar 

  136. Garza E, Jr., Kuhn J, Arnold D, Nicholson W, Reddy S, McCarty T. Internal hernias after laparoscopic Roux-en-Y gastric bypass. Am J Surg. 2004;188(6):796–800. Epub 2004/12/28.

    Article  PubMed  Google Scholar 

  137. Husain S, Ahmed AR, Johnson J, Boss T, O’Malley W. Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management. Arch Surg. 2007;142(10):988–93. Epub 2007/10/17.

    Article  PubMed  Google Scholar 

  138. Nagem R, Lazaro-da-Silva A. Cholecystolithiasis after gastric bypass: a clinical, biochemical, and ultrasonographic 3-year follow-up study. Obes Surg. 2012;22(10):1594–9. Epub 2012/07/07.

    Article  PubMed  Google Scholar 

  139. Nagem RG, Lazaro-da-Silva A, de Oliveira RM, Morato VG. Gallstone-related complications after Roux-en-Y gastric bypass: a prospective study. Hepatobiliary Pancreat Dis Int. 2012;11(6):630–5. Epub 2012/12/13. (HBPD INT).

    Article  PubMed  Google Scholar 

  140. Tarantino I, Warschkow R, Steffen T, Bisang P, Schultes B, Thurnheer M. Is routine cholecystectomy justified in severely obese patients undergoing a laparoscopic Roux-en-Y gastric bypass procedure? A comparative cohort study. Obes Surg. 2011;21(12):1870–8. Epub 2011/08/25.

    Article  PubMed  Google Scholar 

  141. Tucker ON, Fajnwaks P, Szomstein S, Rosenthal RJ. Is concomitant cholecystectomy necessary in obese patients undergoing laparoscopic gastric bypass surgery? Surg Endosc. 2008;22(11):2450–4. Epub 2008/02/22.

    Article  CAS  PubMed  Google Scholar 

  142. Uy MC, Talingdan-Te MC, Espinosa WZ, Daez ML, Ong JP. Ursodeoxycholic acid in the prevention of gallstone formation after bariatric surgery: a meta-analysis. Obes Surg. 2008;18(12):1532–8. Epub 2008/06/25.

    Article  PubMed  Google Scholar 

  143. Chang CG, Adams-Huet B, Provost DA. Acute post-gastric reduction surgery (APGARS) neuropathy. Obes Surg. 2004;14(2):182–9. Epub 2004/03/17.

    Article  PubMed  Google Scholar 

  144. Odom J, Zalesin KC, Washington TL, Miller WW, Hakmeh B, Zaremba DL, et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg. 2010;20(3):349–56. Epub 2009/06/26.

    Article  PubMed  Google Scholar 

  145. Fobi MA, Lee H, Igwe D, Jr., Felahy B, James E, Stanczyk M, et al. Revision of failed gastric bypass to distal Roux-en-Y gastric bypass: a review of 65 cases. Obes Surg. 2001;11(2):190–5. Epub 2001/05/17.

    Article  CAS  PubMed  Google Scholar 

  146. Carrodeguas L, Szomstein S, Soto F, Whipple O, Simpfendorfer C, Gonzalvo JP, et al. Management of gastrogastric fistulas after divided Roux-en-Y gastric bypass surgery for morbid obesity: analysis of 1,292 consecutive patients and review of literature. Surg Obes Relat Dis. 2005;1(5):467–74. Epub 2006/08/24. (official journal of the American Society for Bariatric Surgery).

    Article  PubMed  Google Scholar 

  147. Faria SL, de Oliveira Kelly E, Lins RD, Faria OP. Nutritional management of weight regain after bariatric surgery. Obes Surg. 2010;20(2):135–9. Epub 2008/06/26.

    Article  PubMed  Google Scholar 

  148. Kakarla N, Dailey C, Marino T, Shikora SA, Chelmow D. Pregnancy after gastric bypass surgery and internal hernia formation. Obstet Gynecol. 2005;105(5 Pt 2):1195–8. Epub 2005/05/03.

    Article  PubMed  Google Scholar 

  149. Abodeely A, Roye GD, Harrington DT, Cioffi WG. Pregnancy outcomes after bariatric surgery: maternal, fetal, and infant implications. Surg Obes Relat Dis. 2008;4(3):464–71. Epub 2007/11/03. (Official journal of the American Society for Bariatric Surgery).

    Article  PubMed  Google Scholar 

  150. Josefsson A, Bladh M, Wirehn AB, Sydsjo G. Risk for congenital malformations in offspring of women who have undergone bariatric surgery. A national cohort. BJOG. 2013. Epub 2013/08/10. (an international journal of obstetrics and gynaecology).

    Google Scholar 

  151. Shai D, Shoham-Vardi I, Amsalem D, Silverberg D, Levi I, Sheiner E. Pregnancy outcome of patients following bariatric surgery as compared with obese women: a population-based study. J Matern Fetal Neonatal Med. 2013. Epub 2013/06/19. (the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet).

    Google Scholar 

  152. Kjaer MM, Lauenborg J, Breum BM, Nilas L. The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study. Am J Obstet Gynecol. 2013;208(6):464 e1–5. Epub 2013/03/08.

    Article  Google Scholar 

  153. van der Beek ES Te Riele W Specken TF Boerma D van Ramshorst B. The impact of reconstructive procedures following bariatric surgery on patient well-being and quality of life. Obes Surg. 2010;20(1):36–41. Epub 2009/08/19.

    Article  PubMed  Google Scholar 

  154. Modarressi A, Balague N, Huber O, Chilcott M, Pittet-Cuenod B. Plastic surgery after gastric bypass improves long-term quality of life. Obes Surg. 2013;23(1):24–30. Epub 2012/08/28.

    Article  CAS  PubMed  Google Scholar 

  155. de Kerviler S Husler R Banic A Constantinescu MA. Body contouring surgery following bariatric surgery and dietetically induced massive weight reduction: a risk analysis. Obes Surg. 2009;19(5):553–9. Epub 2008/08/30.

    Article  PubMed  Google Scholar 

  156. van der Beek ES van der Molen AM van Ramshorst B. Complications after body contouring surgery in post-bariatric patients: the importance of a stable weight close to normal. Obes Facts. 2011;4(1):61–6. Epub 2011/03/05.

    Article  PubMed  Google Scholar 

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Acknowledgment

The authors would like to acknowledge Wendy Anderson, registered dietitian at Boston Medical Center, for her suggestions contributing to this chapter.

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  1. King Chulalongkorn Memorial Hospital, Division of Endocrinology and Metabolism, Department of Medicine, Chulalongkorn University, Thai Red Cross Society, 1873 Rama 4 Rd, Pathum Wan, 10330, Bangkok, Thailand

    Patchaya Boonchaya-Anant MD

  2. Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston Medical Center, 88 East Newton Street, Robinson 4400, 02118, Boston, MA, USA

    Amanda G. Powell MD & Caroline M. Apovian MD

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  1. Patchaya Boonchaya-Anant MD
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Correspondence to Caroline M. Apovian MD .

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  1. Assistant Professor of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA

    Adrienne Youdim

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Boonchaya-Anant, P., Powell, A., Apovian, C. (2015). Perioperative Care of the Surgical Patient. In: Youdim, A. (eds) The Clinician’s Guide to the Treatment of Obesity. Endocrine Updates. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2146-1_10

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