Micronutrient deficiencies are a concern after bariatric surgery. Iron deficiency is common in this patient group regardless of surgical procedure. Iron deficiency can be treated effectively with oral supplements, however in some cases an iron infusion is warranted to correct iron levels in patients who don’t respond to or don’t tolerate oral supplements.
Pathology results from patients requiring iron infusions as a consequence of persistently low ferritin in a high volume bariatric surgery centre over a 2 year period were analysed. Patients referred for iron infusion were also referred for dietetic input.
There were 214 revision procedures performed in this surgical centre during the 2 year period. 180 (84%) of these were revising LAGB to GB. Of the 39 patients requiring iron infusion, 13 warranted infusion prior to a primary surgical procedure (laparoscopic sleeve gastrectomy (LSG) or gastric bypass (GB)). The remaining 26 (66%) patients that received infusions were detected prior to revision bariatric surgery. 18 (46%) of these were conversion from gastric banding (LAGB) to gastric bypass (GB). Therefore 10% of the LAGB patients having revision surgery required an iron infusion to correct low ferritin.
LAGB has been widely performed in Australia in recent decades. Many patients with LAGB are now presenting for revision surgery as a consequence of insufficient weight loss, poor food tolerance and reflux. Often these patients have tolerated symptoms for some time before seeking further surgical intervention. They have commonly been lost to follow up by the multi-disciplinary team and may not have had regular dietetic counselling. Our audit results indicate this patient group would benefit from long term follow up to identify poor food tolerance, detect deficiencies early and correct accordingly.