From the Guidelines
Patients should follow up with their bariatric surgeon for at least 2 years after surgery, with lifelong monitoring of nutritional status recommended at least annually as part of shared-care management. This recommendation is based on the most recent and highest quality study, which emphasizes the importance of long-term follow-up care to ensure that nutritional requirements are met and risks of developing post-bariatric surgery-related nutritional deficiencies are reduced 1.
Key Components of Follow-up Care
- Specialist postoperative dietetic support, including individualized nutritional supplementation, support, and guidance to achieve long-term weight loss and weight maintenance 1
- Monitoring of nutritional intake, dietary and nutritional assessment, advice, and support 1
- Laboratory tests to check for nutritional deficiencies, including vitamins B12, D, iron, calcium, and protein levels 1
- Evaluation of the need for medication adjustments and assessment of overall health outcomes 1
Importance of Long-term Follow-up
Long-term follow-up is essential because nutritional deficiencies can develop years after surgery, weight regain may occur, and anatomical complications might arise later 1. Patients who maintain regular follow-up care typically experience better long-term weight maintenance and health outcomes compared to those who discontinue care prematurely 1.
Schedule for Follow-up Appointments
The schedule for follow-up appointments may vary depending on the type of bariatric procedure and individual patient needs. However, the first year typically requires more intensive monitoring, with visits scheduled at regular intervals, and annual check-ups are generally recommended after the first year 1.
From the Research
Recommended Duration for Follow-up after Bariatric Surgery
- The recommended duration for patients to follow up with the bariatric surgeon after bariatric surgery is lifelong, as stated in studies 2, 3, 4.
- A study published in 2021 found that patients who have bariatric surgery are not receiving the recommended nutritional monitoring after discharge from specialist care, highlighting the need for long-term follow-up 5.
- Another study published in 2013 reported 15-year follow-up data after laparoscopic adjustable gastric banding and found that long-term weight loss was maintained, with 47% excess weight loss at 15 years 6.
- Current guidance recommends annual long-term follow-up after bariatric surgery, but attendance can be low, and failure to attend is associated with poorer outcomes 4.
Factors Affecting Follow-up
- Travel issues were mentioned as the main reason for being lost to follow-up in one study 2.
- Male sex, younger age, absence of type 2 diabetes, and poor 1-year follow-up were predictors of poor 5-year follow-up in another study 3.
- Patient self-efficacy and healthcare professional factors such as a non-judgemental attitude, knowledge, and continuity of care were enablers to attending follow-up care, while unrealistic patient expectations and perceived lack of healthcare professional expertise were barriers 4.
Importance of Long-term Follow-up
- Long-term follow-up is crucial for monitoring and managing comorbidities, as well as addressing procedure-specific problems and weight regain 4.
- A systematic review of the literature found that substantial and similar long-term weight losses were achieved with different bariatric procedures, highlighting the importance of long-term follow-up 6.