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Çalapkorur et al. Mini-invasive Surg 2020;4:15 I http://dx.doi.org/10.20517/2574-1225.2019.51 Page 5 of 7

Data from the literature indicate that vitamin D deficiency is observed following many bariatric
procedures [13,42-47] . In these patients, it is known that bone turnover is accelerated in relation to low bone
mineral density and this poses a risk for bone fractures. Therefore, it is very important to regularly monitor
the vitamin D levels of patients after surgery and, if necessary, provide vitamin D supplementation [24,48,49] .

In the treatment of vitamin D deficiency, 50,000 IU ergocalciferol support once a week for 12 weeks,
and then, 1000-5000 IU/day cholecalciferol support is recommended [20,23] . In patients with osteomalacia,
50,000 IU ergocalciferol should be given once a week and 600,000 IU ergocalciferol supplementation
in total should be reached in 12 weeks. However, there is also evidence that high-dose oral vitamin D
supplementation causes liver abnormalities and hypercalcemia. Therefore, patient follow-up should be
[24]
performed regularly during and after supplementation .

Vitamin E
[38]
In the study carried out by Cuesta et al. , anthropometric measurements and vitamin levels of 178
patients who underwent 116 RYGB and 62 BPD operations were evaluated before and after surgery. In
the first year following RYGB, vitamin E deficiency was not found in the patients and the prevalence of
vitamin E deficiency was 4.8% in the first year following BPD.

In case of deficiency, 800-1200 IU/day oral vitamin E supplementation was recommended [20,23,24] .

Vitamin K
Vitamin K deficiency was reported to be rare in the short term after RYGB. Nevertheless, in a study in which
[50]
BPD patients were followed up for 42 months, vitamin K deficiency was determined in 60% of patients .
It is recommended that vitamin K deficiency be treated with either 2.5-25.0 mg/day of vitamin K taken
orally or 5-15 mg parenteral vitamin K supplementation taken intramuscularly or subcutaneously [20,23,24] .

CONCLUSION AND RECOMMENDATIONS
One of the most common complications observed in patients after bariatric surgery is vitamin deficiencies.
These deficiencies can negatively affect the quality of life, nutritional behavior, and the goals that are
desired to be achieved after surgery by causing many biochemical and clinical disorders in patients.
Therefore, regular follow-up of patients after surgery is very important. If any vitamin deficiency is detected
in the patient biochemically or clinically, relevant vitamin deficiency should be eliminated immediately
through supplementation.

It was reported that vitamin deficiencies are more common in malabsorptive surgery methods; therefore,
the patient’s bariatric surgery procedure should also be considered while applying vitamin supplementation.

In patients who underwent restrictive surgery, adequate and balanced nutrition should be provided after
surgery via the nutrition programs prepared by expert dietitians to prevent vitamin deficiency.

In addition, vitamin deficiencies that exist before surgery in patients may get worse after surgery. Therefore,
vitamin levels should be evaluated before surgery and if there is deficiency it must be treated before the
operation.

DECLARATIONS
Authors’ contributions
Did the literatüre review, summarized the studies on the subject: Küçükkatirci H
Made the studies that are summarized on the subject into an article: Çalapkorur S
Reviewed and approved the final version of the article: Çalapkorur S, Küçükkatirci H