Malabsorptive Bariatric Procedures Research Articles

#2827 Beyond the scale: unveiling the kidney stone risk after bariatric surgery

Abstract Background and Aims Nephrolithiasis is a prevalent condition, with calcium oxalate being the primary component found in kidney stones. Both obesity and gastric bypass surgery pose as risk factors for nephrolithiasis. Malabsorptive bariatric procedures alter 24-hour urine profiles, leading to increased urinary oxalate and reduced urinary citrate levels. This study aims to evaluate the risk factors for calcium oxalate lithiasis in a population after gastric bypass surgery at our center. Method We performed a monocentric retrospective study to evaluate hyperoxaluria and urinary lithiasis in patients who underwent gastric bypass surgery between 2020 and 2021. We assessed urinary oxalate excretion, urinary citrate excretion, and urinary sodium excretion between 4 and 28 months after surgery. To confirm the adequacy of the collection, a comparison was made with the expected urinary creatinine value (20 to 25 mg/kg ideal weight for men and 15 to 20 mg/kg ideal weight for women). We developed a risk score: citraturia < 288 mg/24 h (1 point); oxaluria > 45 mg/L (1 point) and natriuresis > 97.75 mmol/24 h (1 point). Patients were classified as without risk (0 points), at low risk (1 point), at high risk (2 points), and at very high risk (3 points). Additionally, the patients’ historical incidence of lithiasis was examined, both preoperatively and postoperatively, using clinical records. Post-surgery assessments included imaging evidence of lithiasis (when available) or clinical episodes of renal colic. Results Fifty-six patients underwent a 24-hour urine collection. Twenty-two were excluded due to incomplete urine collection, determined by the expected urinary creatinine value and a time lapse exceeding 28 months between surgery and analytical assessment. The median time elapsed between surgery and analytical evaluation was 9.5 months [IQR 6.3 - 12] months. A total of 34 patients were included in the study, 8.8% were male and the median age of the patients was 51.5 [IQR 42.3–57.8] years. The median body mass index decreased from 43.1 [IQR 39.7–46.3] kg/m2 before to 31.8 [IQR 28.6–35.7] kg/m2 six months after surgery. The low risk for calcium oxalate lithiasis in the examined patient sample was 52.9% (n = 18); high risk 20.6% (n = 7), no risk 26.5% (n = 9) and very high risk 0%. We detected 3 (8.8%) patients with concentration hyperoxaluria, 20 (58.8%) patients with natriuresis > 97.75 mmol/24 h and 8 (23.5%) patients with reduced urinary citrate levels. All patients exhibited normal kidney function. The median follow-up duration was 27 months. Out of the total number of patients, only 3 reported renal colic episodes, and imaging evidence of lithiasis was found in just 2 of them before surgery. Among those with a risk score > 0, only 1 had a history of lithiasis. Throughout the follow-up period, none of the patients experienced new lithiasis post-surgery. Regarding the limitations of our study, we highlight the relatively brief duration of follow-up, which may pose challenges in comprehensively evaluating outcomes such as lithiasis. Additionally, the absence of imaging screening represents a notable constraint, impeding the comprehensive assessment of patients with asymptomatic lithiasis. Conclusion This study concludes that within the bariatric surgery population, a specific subgroup is at an elevated risk for renal lithiasis. Recognizing this subgroup promptly and instituting heightened preventive measures may prove advantageous within this demographic.

One Anastomosis Gastric Bypass Surgery: Consequences Over Ascorbic Acid, Cobalamin, Calciferol, and Calcium

Background: Nutrient deficiency after malabsorptive bariatric procedure is a common phenomenon. The study aims to determine the prevalence of nutritional insufficiencies (specific with Ascorbic acid, Cobalamin, calciferol and calcium) in obese population opting for One Ananstomosis Gastric Bypass surgery (OAGB), and also to understand the association of these nutrients with change in Body Mass Index (BMI) after the surgery.
 Methods: One hundred fifty subjects comprising males and females aged 20-60 years were randomly selected at a bariatric center in India. Subjects belonged to both grade III and grade II obesity. Plasma aa, serum vitB12, serum VitD3 and serum calcium concentrations were prospectively assessed at 0m, 3m, and 6m of surgery through high-performance liquid chromatography.
 Result: The values of nutrients beyond the standard levels are considered as deficiency. Both follow up values showed a significant increase in cobalamin, Calciferol, and ascorbic acid levels compared to baseline data.
 Conclusion: Nutrition depletion and deficiency are often seen in post bariatric cases. The contributing factors included high BMI, food intolerance, and non-adherence to supplements and correct dietary regimens. With the correction of weight and comorbidities, the levels also showed a stable and positive level.
 Bangladesh Journal of Medical Science Vol. 22 No. 03 July’23 Page : 695-708

Long-Term Outcomes of Revisional Malabsorptive Bariatric Surgery: Do the Benefits Outweigh the Risk?

PurposeTo evaluate the long-term outcomes of revisional malabsorptive bariatric surgery.Materials and MethodsMalabsorptive bariatric procedures are increasingly performed in the revisional setting. We collated and analysed prospectively recorded data for all patients who underwent a revisional Biliopancreatic diversion + / − duodenal switch (BPD + / − DS) over a 17-year period.ResultsWe identified 102 patients who underwent a revisional BPD + / − DS. Median follow-up was 7 years (range 1–17). There were 21 (20.6%) patients permanently lost to follow-up at a median of 5 years postoperatively. Mean total weight loss since the revisional procedure of 22.7% (SD 13.4), 20.1% (SD 10.5) and 17.6% (SD 5.5) was recorded at 5, 10 and 15 years respectively. At the time of revisional surgery, 23 (22.5%) patients had diabetes and 16 (15.7%) had hypercholesterolaemia with remission of these occurring in 20 (87%) and 7 (44%) patients respectively. Nutritional deficiencies occurred in 82 (80.4%) patients, with 10 (9.8%) patients having severe deficiencies requiring periods of parenteral nutrition. Seven (6.9%) patients required limb lengthening or reversal procedures. There were 16 (15.7%) patients who experienced a complication within 30 days, including 3 (2.9%) anastomotic leaks. Surgery was required in 42 (41.2%) patients for late complications.ConclusionRevisional malabsorptive bariatric surgery induces significant long-term weight loss and comorbidity resolution. High rates of temporary and permanent attrition from follow-up are of major concern, given the high prevalence of nutritional deficiencies. These data question the long-term safety of malabsorptive bariatric procedures due to the inability to ensure compliance with nutritional supplementation and long-term follow-up requirements.Graphical abstract Key points• Revisional bariatric surgery workload is increasing• Revisional malabsorptive surgery is efficacious for weight loss and comorbidity resolution• Revisional malabsorptive surgery is associated with high rates of nutritional deficiencies• Attrition from follow-up in this specific cohort of patients is of particular concern due to the risk of undiagnosed and untreated nutritional deficienciesSupplementary InformationThe online version contains supplementary material available at 10.1007/s11695-022-06019-7.

Impact of gastrointestinal symptoms and psychological disturbances on patients’ quality of life after restrictive or malabsorptive bariatric surgery

AimThe aim of this study was to evaluate and compare the presence and impact of Gastrointestinal (GI) symptoms, physical and psychological disturbances on patients’ QoL after sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS). MethodsA prospective, observational, cross-sectional, comparative study was carried-out. GI symptoms and patients’ QoL were evaluated by the SF-36 questionnaire and the GI quality of life index (GIQLI). Correlation between GI symptoms, psychological disturbances and QoL scores was analysed. Results95 patients were included (mean age 50.5 years, range 22–70; 76 females). Presence of GI symptoms was a consistent finding in all patients, and postprandial fullness, abdominal distention and flatulence had a negative impact on patients’ QoL. Patients after SG showed a worsening of their initial psychological condition and the lowest QoL scores. Patients after RYGB showed the best GI symptoms-related QoL. ConclusionsBoth restrictive and malabsorptive bariatric surgical procedures are associated with GI symptoms negatively affecting patients’ QoL. Compared to SG and BPD/DS, patients after RYGB showed the best GI symptoms-related QoL, which can be used as additional information to help in the clinical decision making of the bariatric procedure to be performed.

Risk Factors for Kidney Stone Formation following Bariatric Surgery.

Kidney stones are painful, common, and increasing in incidence. Obesity and bariatric surgery rates are also on the rise in the United States. Although bariatric surgery is associated with improvements in metabolic outcomes, malabsorptive bariatric surgery procedures are also associated with increased risk of kidney stones. Restrictive bariatric surgeries have not been associated with kidney-stone risk. Higher risk of kidney stones after malabsorptive procedures is associated with postsurgical changes in urine composition, including high urine oxalate, low urine citrate, and low urine volume. Certain dietary recommendations after surgery may help mitigate these urine changes and reduce risk of kidney stones. Understanding risk of kidney stones after surgery is essential to improving patient outcomes after bariatric surgery.

"Little more than a gut feeling?"-considerations when prescribing psychotropic medications to patients undergoing bariatric surgery.

Bariatric surgical procedures are being commonly performed increasingly, and many surgical candidates are concomitantly taking psychotropic medication. This paper aims to elucidate issues when prescribing psychiatric medication in this setting of substantial anatomical and physiological change. A hand search of the literature to assess the current understanding of effects of various bariatric procedures on the bioavailability of psychotropic medication. Predominantly malabsorptive bariatric procedures may reduce bioavailability of some but not all commonly used psychiatric medications. There is minimal information about the effects of the most commonly performed surgery, vertical sleeve gastrectomy. Lithium prescription and monitoring requires caution. There is limited guidance for prescription for psychotropic medication in the bariatric surgery patient group, and vigilance for unexpected adverse effects or altered efficacy is warranted.

Pathophysiology and Treatment of Enteric Hyperoxaluria.

Enteric hyperoxaluria is a distinct entity that can occur as a result of a diverse set of gastrointestinal disorders that promote fat malabsorption. This, in turn, leads to excess absorption of dietary oxalate and increased urinary oxalate excretion. Hyperoxaluria increases the risk of kidney stones and, in more severe cases, CKD and even kidney failure. The prevalence of enteric hyperoxaluria has increased over recent decades, largely because of the increased use of malabsorptive bariatric surgical procedures for medically complicated obesity. This systematic review of enteric hyperoxaluria was completed as part of a Kidney Health Initiative-sponsored project to describe enteric hyperoxaluria pathophysiology, causes, outcomes, and therapies. Current therapeutic options are limited to correcting the underlying gastrointestinal disorder, intensive dietary modifications, and use of calcium salts to bind oxalate in the gut. Evidence for the effect of these treatments on clinically significant outcomes, including kidney stone events or CKD, is currently lacking. Thus, further research is needed to better define the precise factors that influence risk of adverse outcomes, the long-term efficacy of available treatment strategies, and to develop new therapeutic approaches.

Different Malabsorptive Obesity Surgery Interventions Result in Distinct Postprandial Amino Acid Metabolomic Signatures.

Biliopancreatic diversion with duodenal switch (BPD-DS) is an effective weight loss surgical procedure. Yet, BPD-DS is technically difficult to perform and carries a higher risk of nutrient deficiencies as compared with other surgical interventions. Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a modified BPD-DS procedure conceived with the aim of decreasing the technical complexity, while retaining the weight loss efficiency. Whether the two surgical procedures diverge in nutrient absorption rates and malnutrition risk is still matter of debate. Our aim was to determine if postprandial nutrient absorption rates are different in patients subjected to BPD-DS or SADI-S for weight loss. Plasma amino acid metabolomic profiling during mixed-meal tolerance test (MMTT) was performed in subjects (N = 18) submitted to BPD-DS (n = 9) or SADI-S (n = 9) 1.6 ± 0.1years earlier. Patients submitted to SADI-S or BPD-DS presented distinct postprandial metabolomic profiles. Postprandial excursions of total and essential amino acids-leucine, isoleucine, and valine-were higher after SADI-S as compared with BPD-DS. Our study demonstrates that a simplified malabsorptive bariatric surgery procedure SADI-S results in greater essential branched-chain amino acid absorption when compared with the classical BPD-DS intervention. These findings suggest that SADI-S can potentially lower lifetime risk of postoperative protein malnutrition, as well as have a positive impact on systemic metabolism and glucose homeostasis.

Chylous ascites as a late complication of one anastomosis gastric bypass-minigastric bypass: case report

BackgroundOne anastomosis gastric bypass- minigastric bypass (OAGB-MGB) is an emerging bariatric surgery that is being endorsed by surgeons worldwide. Internal herniation is a rare and dreaded complication after malabsorptive bariatric procedures, which necessitates early diagnosis and intervention.Case presentationWe describe a 29-year-old male with chylous ascites caused by an internal hernia 8 months following laparoscopic one anastomosis gastric bypass. An abdominal CT showed enlargement of lymph nodes at the mesentery, with a moderate amount of liquid in the abdomen and pelvis. An emergent exploratory laparoscopic surgery demonstrated an internal hernia at the Petersen’s space with a moderate quantity of chylous ascites. The patient made an uneventful recovery after surgery.ConclusionsInternal herniation can occur after OAGB-MGB and in extremely rare cases lead to chylous ascites. To our knowledge, this is the first reported case of chylous ascites following one anastomosis gastric bypass.

Healthcare provider knowledge regarding oral contraception effectiveness for women with a history of bariatric malabsorptive procedures

BackgroundClinical practice guidelines that recommend women avoid pregnancy immediately after bariatric surgery, highlighting the need for effective contraception. However, women with a history of malabsorptive bariatric procedures should generally not use oral contraceptives, as these procedures may decrease oral contraceptive effectiveness. ObjectivesTo identify provider characteristics associated with knowledge of combined oral contraceptive (COC) effectiveness. SettingUnited States. MethodsWe analyzed weighted survey data collected from national samples of public-sector health centers and office-based physicians who regularly provide family planning services (N = 2060). We asked providers about the effectiveness of COCs for women with a history of malabsorptive procedures compared with healthy women, giving them the response options of more/equally effective, less effective, and do not know. We used multinomial logistic regression to calculate adjusted odds ratios and 95% confidence intervals to identify characteristics associated with knowledge of COC effectiveness. ResultsApproximately 55% of providers correctly answered that COCs are less effective for women with malabsorptive procedures; 25% considered COCs more/equally effective, and 20% were uncertain. Among public-sector providers, the adjusted odds of uncertainty were significantly higher for those whose clinical focus was not reproductive health, for nurses versus advanced practice clinicians, and for providers working in clinics without Title X funding. For office-based physicians, adolescent medicine providers had higher odds of uncertainty versus obstetrician-gynecologists. Physicians practicing in settings classified as “other” (such as community health centers) had higher odds of considering COCs effective compared with those practicing in hospital or university clinics. ConclusionsSubstantial proportions of surveyed providers had inadequate knowledge of COC effectiveness for women with a history of malabsorptive procedures.

Post-bariatric surgery hidradenitis suppurativa: a new patient subset associated with malabsorption and micronutritional deficiencies.

Bariatric surgery (BS) represents the most effective treatment for morbid obesity and its related complications, potentially ameliorating chronic comorbid inflammatory skin conditions, such as psoriasis and hidradenitis suppurativa (HS). Weight-loss interventions are strongly encouraged in patients with HS, but the resulting effect on the course of the disease has been poorly reported. To describe the effect of BS-associated weight-loss on the course of HS. This was a retrospective, descriptive study of a hospital-based patient cohort with HS in order to investigate the relationship between exposure to a BS procedure and the HS disease course. Clinical characteristics and BS-related outcomes were retrospectively analysed by chart review for identified cases. Laboratory parameters for selected micronutrients (levels of vitamin A, D and B12, plus zinc and iron) were re-evaluated at a follow-up visit in each post-BS case. Typical patients with HS from the general cohort served as controls for the comparison of vitamin D and zinc serum levels. Of 178 patients with HS, 12 patients with incident HS who had undergone a BS procedure were identified. A subset of patients (n=10) developed initial signs and symptoms of cutaneous suppuration after experiencing weight loss related to malabsorptive bariatric procedures. Post-BS patients with HS presented multiple micronutritional deficiencies and insufficient responses to standard, first-line antibiotic treatments. Of the micronutrients we selected for analysis, zinc was found to be at significantly lower serum levels in post-BS patients with HS compared with typical patients with HS. Post-BS HS may represent a new patient subset, requiring customized clinical management.

Differential effects of restrictive and malabsorptive bariatric surgery procedures on the serum lipidome in obese subjects

Bariatric surgery (BS) is the most effective treatment for severe obesity. Our group and others have previously reported that the type of BS (restrictive vs malabsorptive) can lead to different effects on the lipid profile and glucose homeostasis in morbidly obese patients. Furthermore, BS exerts significant changes in lipid metabolism, which are not yet fully understood and that might be dependent of surgical technique. The objective of this study was to evaluate the differential changes in the serum lipidomic profile of morbidly obese subjects who underwent two different BS techniques: sleeve gastrectomy (SG) (restrictive) and biliopancreatic diversion (BPD) (malabsorptive). This study included 37 morbidly obese patients (body mass index≥40kg/m2) who underwent either SG (n=25) or BPD (n=12). Serum lipid extracts were assessed at baseline and 6months after BS and were analyzed in a ultra-high performance liquid chromatography time-of-flight mass spectrometry-based platform. SG not only restores the circulating levels of fatty acids and glycerolipids to similar levels to those observed in nonobese subjects but also results in a consistent increase of phospholipid and sphingolipid species, ranging from antioxidant plasmalogens to lipotoxic ceramides. BPD, however, leads to an overall reduction in circulating fatty acids, glycerolipids, phospholipids and sphingolipids, and a substantial increase of bile acids. Our lipidomic analysis suggests that the differential metabolic effects typically observed after restrictive vs malabsorptive BS procedures could be explained, at least partially, to BS-specific lipid changes and provides novel aspects of lipid remodeling in obesity during weight loss.

Nutritional Deficiency After Sleeve Gastrectomy: A Comprehensive Literature Review

Sleeve gastrectomy (SG) has been recognised as an effective procedure for the treatment of morbid obesity and associated comorbidities; however, the shortcomings of SG, such as staple line leak, haemorrhage, vomiting, and weight regain, have also been well-reported. An underestimated adverse effect of SG is nutritional deficiency (ND). While ND is a well-known complication of malabsorptive bariatric procedures, it can still occur after restrictive operations, including SG, yet its incidence and mechanism are still unclear. In an attempt to learn about the incidence and type of ND after SG we performed an organised literature search of electronic databases searching for articles that assessed the incidence and type of ND after SG. The median incidence of iron and zinc deficiency after SG was 8.8% and 18.8%, respectively. The majority of patients already had vitamin D deficiency preoperatively, with a median of 35.5% of patients still demonstrating vitamin D deficiency postoperatively. Comparing ND before and after SG, the incidence of iron and vitamin D deficiency declined postoperatively; in contrast, there was a tangible increase in the incidence of vitamin B1, B6, B12, and calcium deficiency. Vitamin B1 and B12 deficiencies were recorded in a median of 10.0% and 11.7% of patients, respectively, and were associated with neurologic manifestations in <1% of patients. Prevention of ND after SG requires proper recognition and correction of preoperative ND with immediate supplementation of trace elements and vitamins postoperatively, in addition to long follow-up.

Laparoscopic bariatric surgery-current trends and controversies

Although the origins of bariatric surgery to treat obesity can be traced back to the 1950s with the jejunoileal bypass, which is considered a malabsorptive bariatric procedure, its practice remained in obscurity until two things happened. First, obesity becoming a pandemic disease state with life threatening comorbidities such as diabetes, hypertension, sleep apnea, dyslipidemia and metabolic syndrome, resulting in a higher risk for premature death. Second, the introduction, development, and refinement of minimal access surgical techniques along with newer laparoscopic stapling devices. With the advent of laparoscopy in the 1980s, bariatric surgery began to be performed through minimally invasive techniques. The purpose of this article is to describe the science and evolutionary development of various laparoscopic bariatric surgical techniques and the associated surgical anatomy.

Laparoscopic bariatric surgery-current trends and controversies

Although the origins of bariatric surgery to treat obesity can be traced back to the 1950s with the jejunoileal bypass, which is considered a malabsorptive bariatric procedure, its practice remained in obscurity until two things happened. First, obesity becoming a pandemic disease state with life threatening comorbidities such as diabetes, hypertension, sleep apnea, dyslipidemia and metabolic syndrome, resulting in a higher risk for premature death. Second, the introduction, development, and refinement of minimal access surgical techniques along with newer laparoscopic stapling devices. With the advent of laparoscopy in the 1980s, bariatric surgery began to be performed through minimally invasive techniques. The purpose of this article is to describe the science and evolutionary development of various laparoscopic bariatric surgical techniques and the associated surgical anatomy.

Recent Trends in Endoscopic Bariatric Therapies.

Obesity and its associated metabolic diseases including diabetes mellitus are severe medical problems that are increasing in prevalence worldwide and result in significant healthcare expenses. While behavioral and pharmacological treatment approaches are partly effective in the short term, their effects are not long-lasting. Although previous studies have described bariatric surgery as the most effective treatment for obesity, it is associated with morbidity, mortality, and economic burden. Endoluminal interventions performed entirely using gastrointestinal flexible endoscopy offer alternative approaches to the treatment of obesity that are safer and more cost-effective than current surgical approaches. The use of endoluminal techniques in the field of metabolic obesity disease has diverse promising applications including endoscopic gastroplasty, intragastric balloon, endoluminal malabsorptive bariatric procedures, and gastric electrical stimulation (GES) for the modulation of gastric emptying. This review discusses recent trends and roles in endoscopic bariatric therapies using the currently available endoluminal and transgastric technologies.

A5204 - Switching Biliopancreatic diversion to Roux-Y bypass treats complications and failure to lose weight

Introduction: Bariatric surgery is an effective method of treatment for morbid obesity as it provides not only weight loss but also resolution of obesity-related co-morbidities. The aim of this study was to evaluate the clinical efficacy of malabsorptive procedures (Laparoscopic Gastric Bypass-LGBP & Duodenal Switch-DS) versus restrictive procedures (Laparoscopic Sleeve Gastrectomy-LSG) as it relates to percentage excess weight loss, postoperative complications & resolution of comorbidities. Methods: A systematic review was conducted identifying all relevant studies from 2005 – 2015 with comparative data on malabsorptive and restrictive procedures. The primary outcome was percentage excess weight loss and postoperative complications (leaks, bleeding, strictures etc.).The secondary outcome was resolution of comorbidities (Diabetes Mellitus-DM, Hyperlipidemia-HLP, Gastroesophageal Reflux Disease-GERD & Hypertension-HTN). The results were analyzed as standard difference in means with standard error. Statistical analysis was done using random-effects meta-analysis to compare the mean value of the two groups (Comprehensive Meta-Analysis Version 3.3.070 software; Biostat Inc., Englewood, NJ). Results: Thirteen studies were quantitatively assessed and included for meta-analysis including one double-blind randomized controlled trial, two randomized controlled trials, three prospective studies and seven retrospective studies. There were a total of 3,035 LGBP patients, 155 DS patients, and 2006 LSG patients. Malabsorptive procedures were associated with greater %EWL (-0.070 0.03; p1⁄40.02) and postoperative complications (2.03 0.07; po 0.001) when compared to restrictive procedures. GERD demonstrated greater postoperative occurrence in restrictive procedures compared to malabsorptive procedures (-2.05 0.07; po 0.001). Malabsorptive procedures were associated with greater resolution of comorbidities in terms of DM (0.87 0.07; po 0.001), HLP (1.03 0.09; po 0.001) & HTN (-0.48 0.65; po 0.001). CONCLUSIONS Malabsorptive bariatric procedures yielded significantly higher percentage excess weight loss, rate of postoperative complications and resolution of comorbidities than restrictive procedures.

A5203 - Are the postoperative outcomes of malabsorptive bariatric procedures truly superior to restrictive bariatric procedures?

A5203 - Are the postoperative outcomes of malabsorptive bariatric procedures truly superior to restrictive bariatric procedures?

Petersen’s internal hernia complicating a laparoscopic omega loop gastric bypass

Petersen’s internal hernia complicating a laparoscopic omega loop gastric bypass Laurent Genser, M.D.*, Sergio Carandina, M.D., Antoine Soprani, M.D. Department of Digestive and Hepato-Pancreato-Biliary Surgery, Assistance Publique-Hopitaux de Paris (AP-HP), Pitie-Salpetriere University Hospital, Pierre & Marie Curie University, Paris, France Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Integre Nord Francilien de la prise en charge de l’Obesite (CINFO), Universite Paris XIII-UFR SMBH “Leonard de Vinci,” AP-HP, Bondy, France Department of Digestive Surgery, Clinique Geoffroy-Saint Hilaire, Paris, 75005, France Received April 26, 2015; accepted May 3, 2015

Vitamin and Mineral Deficiencies After Biliopancreatic Diversion and Biliopancreatic Diversion with Duodenal Switch--the Rule Rather than the Exception.

Malabsorptive bariatric procedures, like the biliopancreatic diversion (BPD) and BPD with duodenal switch (BPD/DS), have excellent results in terms of weight loss. However, these malabsorptive techniques are associated with severe malnutrition and vitamin deficiencies. The aim of this study was to evaluate the vitamin and mineral status after BPD and BPD/DS in the long term. All patients who underwent BPD or BPD/DS were selected and invited for an additional follow-up (FU) visit, including blood sampling for vitamin and mineral levels. Forty patients completed the blood sampling with a median FU of 42 (range 12-90) months. At that time, all patients used some kind of supplementation. However, 93 % of all patients were diagnosed with a deficiency. There were no significant differences in mean serum level vitamins and minerals between BPD and BPD/DS. Forty-three per cent of the patients were anaemic, and 40 % had an iron deficiency (ID). High deficiency rates for fat-soluble vitamins were present: vitamin A in 28 %, vitamin D in 60 %, vitamin E in 10 % and vitamin K in 60 % of the patients. Hypervitaminosis was found in 43 % of the patients for vitamin B1 and in 50 % for vitamin B6. High numbers of vitamin and mineral deficiencies were found after BPD and BPD/DS despite vitamin supplementation. Anaemia, ID and deficiencies for fat-soluble vitamins are frequently diagnosed. Repeated monitoring is necessary to detect deficiencies at an early stage. Taking all of this into consideration, a stringent multivitamin supplementation regimen should be implemented after malabsorptive procedures.