Clinical Results and Nutritional Consequences of Biliopancreatic Diversion: Three Years of Follow-Up

Abstract

Background: Bariatric surgery is the most effective long-term treatment for morbid obesity, reducing obesity-associated comorbidities. The aim of our work was to describe clinical results and nutritional complications in morbidly obese patients with biliopancreatic diversion. Methods: We have analyzed a consecutive series of 64 patients who have been followed up for 3 years after undergoing open biliopancreatic diversion by the Scopinaro technique. Results: Initial excess weight loss was 29.3% at 6 months and 61.5% at 3 years. A significant improvement of body mass index, weight, waist circumference, fat mass, glucose level, total cholesterol, uric acid and triglycerides levels was detected. Ferritin, vitamin A, vitamin D, vitamin B₁₂, zinc and copper levels showed a low percentage of deficiency at basal time, but during the follow-up, the percentage of deficiency increased. Vitamin E and K did not show basal deficiency. However, after surgery, a moderate deficiency of both vitamins was detected (vitamin E 7.1% and vitamin K 8.3%). Folic acid deficiency was observed in 54.3% of the subjects at basal time, but decreased during the study. Conclusion: Biliopancreatic diversion is an effective method of sustainable weight loss. However, micronutrient deficiencies can occur.

Bileopancreatic Diversion with Duodenal Switch Lowers Both Early and Late Phases of Glucose, Insulin and Proinsulin Responses After Meal

“…Weight loss changes uric acid metabolism by increasing renal clearance [39]. The observed long-term improvement and markedly lowered uric acid over 3 years after BPD-DS in the present study are more pronounced than earlier data report after BPD without DS [40].…”

Effect of a Single ‘Megadose’ Intramuscular Vitamin D (600,000 IU) Injection on Vitamin D Concentrations and Bone Mineral Density Following Biliopancreatic Diversion Surgery

“…Furthermore, intramuscular supplementation in an oily depot form may lead to VitD levels being better sustained over time. In fact, some studies of BPD patients have shown low VitD levels [7,8,17] and high PTH levels [7,8,[17][18][19] approximately 1-4 years following surgery despite VitD oral supplementation, whereas one study found that the VitD deficiency and PTH elevation post-BPD was resolved in the majority of patients using oral supplements [20]. Also, Marceau et al [7] found that, in a study of 33 BPD patients, one-third of study participants self-reported non-compliance with oral VitD and calcium supplements.…”

Nutritional deficiencies in pregnancy after surgery for morbid obesity

“…[20,42]. According to the results of the reviewed studies (Table 3), pre-operative folate deficiency has been estimated to exist in up to 54% of the subjects, whereas recent studies from the USA support that this prevalence is much lower, about 0-6% [34][35][36]. Five studies found that the prevalence of follic acid deficiency one year after BS ranges between 0% and 15% [17,19,25,26,37] .…”