Refeeding Syndrome After Metabolic and Bariatric Surgery: A Systematic Review of the Literature

Refeeding syndrome (RFS) is defined as a set of metabolic and electrolyte abnormalities after nutrition initiation following prolonged starvation or protracted vomiting. Metabolic and bariatric surgery (MBS) and the associated rapid weight loss have been proposed as potential triggering factors for RFS.

This study aimed to examine the currently available literature and provide an overview of the reported cases of RFS in patients who underwent metabolic and bariatric surgery.

We performed a systematic screening of Embase, Medline, and Scopus until June 2024. The review was conducted according to PRISMA guidelines.

We identified a total of nine patients with RFS who had a history of metabolic and bariatric surgery with a median age of 38 years (IQR 32-44). Five participants (55.5%) were females, and two were males (22.2%). Adjustable gastric banding was the main bariatric procedure performed in almost half of the patients (44.4%, 4/9) followed by Roux-en-Y gastric bypass (22.2%, 2/9). Post-operatively, all patients experienced weight loss that ranged from 29.7% to 78.1% total percentage weight loss. The most common symptoms included vomiting (44.4%, 4/9) and abdominal pain (22.2%, 2/9). Most patients (66.6%, 6/9) received vitamin supplementation, followed by electrolyte replacement (55.5%, 5/9). Most patients (88.8%, 8/9) improved, and one patient died (11%, 1/9).

Refeeding syndrome is a rarely reported complication after metabolic and bariatric surgery, but as the frequency of MBS increases, RFS is expected to become more common. Clinical awareness among bariatric and metabolic specialists is important for the identification of high-risk individuals as well as for the early diagnosis and adequate management of patients with RFS.