STARVATION INJURY AFTER GASTRIC REDUCTION FOR OBESITY

Gastric reduction operations are designed to control body weight by es tablishing a small, meal-size juxtaesophageal, gastric pouch that empt ies into the jejunum (gastric bypass) or the larger portion of the sto mach (gastroplasty). If the outlet of the pouch is too small, a patien t may be limited to ingesting clear liquids. Vomiting then occurs if h eavier liquids or normal foods are taken. An occasional patient has di fficulty eating properly and vomits even though the pouch volume and o utlet are of optimum size. For a patient who reports vomiting, a disti nction must be made between episodic improper cating and uncontrolled starvation. Three types of starvation injury are described: (Ii sudden death from protein malnutrition; (2) refeeding syndrome; and (3) Wern icke-Korsakoff syndrome. The mechanisms of the development, manifestat ions, prevention, and treatment of these complications are explained. Surgeons who treat severe obesity should be aware of these complicatio ns and be prepared to manage patients who have uncontrolled vomiting s o that such complications either do not develop or are recognized and treated as early as possible before serious and irreversible injury oc curs.