Laparoscopic Sleeve Gastrectomy in Super Obese Patient. A Case Study on Pre & Post-operative Nutritional Management

Maria Ulfah W1, Nur Amirah AA1, Norashikin R2
1. International Islamic University Malaysia 2. Hospital Sungai Buloh

Assessment: A 38-years-old female who was in the waiting list for Bariatric surgery was admitted for elective laparoscopic sleeve gastrectomy on 8th February. She was referred to dietitian for Very Low Calorie Diet (VLCD) and optimization prior to surgery. The patients BMI was 52kgm2 and was categorized as type IV obesity or super obese. Laboratory data revealed normal blood glucose, lipid profile and renal profile. In addition, patient had Obstructive Sleep Apnea (OSA), early stage right knee Osteoarthritis (OA) and diagnosed with spondylolisthesis of L4/L5. Few adjustments have been made upon provision of VLCD through ONS. Patient reported unable to tolerate well with regime provided.

Diagnosis: Predicted inadequate energy intake related to decreased in ability to consume ONS regime prescribed as evidenced by energy intake of 113 kcal/day (36% of energy requirement) with complain of vomiting due to the smell and bold taste of the milk as compared to requirement 800kcal/day.

Intervention: Nutritional intervention aimed to achieve 100% of energy and protein requirement since patient need to be optimized pre-operatively. Thus ONS changed to flavored milk; Diabetisol (cappuccino).

Monitoring and Evaluation: Follow up was continued to monitor adherence towards VLCD and feeding plan revised accordingly. Apart from dietary management; series of educational classes were given to help patient continue weight loss after surgery. Postoperative nutritional management focused on capacity of the new stomach pouch. VLCD regime resumed with smaller volume. Upon discharge, patient was allowed to eat normally following post-gastrectomy diet.