Obesity Surgery

, Volume 27, Issue 7, pp 1645–1650 | Cite as

Weight Loss and Nutritional Outcomes 10 Years after Biliopancreatic Diversion with Duodenal Switch

  • Philippe Topart
  • Guillaume Becouarn
  • Jacques Delarue
Original Contributions



Biliopancreatic diversion with duodenal switch (BPD/DS) is the most effective bariatric surgical procedure, but major concerns exist about the nutritional consequences.


The study reported weight loss and nutritional outcomes of 80 patients with a follow-up of at least 10 years.


The follow-up was conducted at a university hospital as well as in a private practice institution in France.


Eighty patients operated on between February 2002 and May 2006 were reviewed. Weight outcomes were analyzed as well as complete biological status. Revisions were reported as well as the number of patients taking vitamin supplementation.


A follow-up of 141 ± 16 months was available for 87.7% of the patients at least 10 years from surgery. Preoperative BMI decreased from 48.9 ± 7.3 to 31.2 ± 6.2 kg/m2 with an EWL of 73.4 ± 26.7% and a TWL of 35.9% ± 17.7%. Despite weight regain ≥10% of the weight loss in 61% of the cases, 78% of the patients maintained a BMI <35. Fourteen percent of the patients had a revision. Normal vitamin D levels were found in 35.4%. The overall PTH level was 91.9 ± 79.5 ng/mL, and 62% of the patients had hyperparathyroidism. Other deficiencies were less frequent but fat-soluble deficiencies as well as a PTH >100 ng/mL were significantly associated with the absence of vitamin supplementation.


BPD/DS maintains a significant weight loss, but remains associated with side effects leading to revision and multiple vitamin deficiencies. The most severe deficiencies are related to the lack of supplementation compliance.


Biliopancreatic diversion Vitamins Malnutrition Weight loss Long-term results 


Authors’ Contribution

Dr. Topart received personal fees for teaching from Ethicon, Covidien, Olympus, and Baxter for teaching as well as meeting travel expense support from Ethicon.

Dr. Becouarn received personal fees for teaching from Ethicon, Covidien, and Olympus.

Dr. Delarue has nothing to disclose.

None of these financial relationships are related to this work.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Scopinaro N, Gianetta E, Civalleri D, et al. The bilio-pancreatic bypass for functional surgical treatment of obesity. Minerva Med. 1979;70:3537–47.PubMedGoogle Scholar
  2. 2.
    Lagacé M, Marceau P, Marceau S, et al. Biliopancreatic diversion with a new type of gastrectomy: some previous conclusions revisited. Obes Surg. 1995;5(4):411–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23:427–36.CrossRefPubMedGoogle Scholar
  4. 4.
    Topart P, Becouarn G, Sallé A, et al. Biliopancreatic diversion requires multiple vitamin and micronutrient adjustments within 2 years of surgery. Surg Obes Relat Dis. 2014;10:936–41.CrossRefPubMedGoogle Scholar
  5. 5.
    Hess DS, Hess DW, Oakley RS. The biliopancreatic diversion with the duodenal switch: results beyond 10 years. Obes Surg. 2005;15:408–16.CrossRefPubMedGoogle Scholar
  6. 6.
    Marceau P, Biron S, Marceau S, et al. Long-term metabolic outcomes 5 to 20 years after biliopancreatic diversion. Obes Surg. 2015;25(9):1584–93.CrossRefPubMedGoogle Scholar
  7. 7.
    Bolckmans R, Himpens J. Long-term (>10 yrs) outcome of the laparoscopic biliopancreatic diversion with duodenal switch. Ann Surg. 2016Google Scholar
  8. 8.
    Sethi M, Chau E, Youn A, et al. Long-term outcomes after biliopancreatic diversion with and without duodenal switch: 2-, 5-, and 10-year data. Surg Obes Relat Dis. 2016. In Press.Google Scholar
  9. 9.
    Biron S, Hould FS, Lebel S, et al. Twenty years of biliopancreatic diversion: what is the goal of the surgery? Obes Surg. 2004;14:160–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Slater GH, Ren CJ, Siegel N, et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004;8:48–55.CrossRefPubMedGoogle Scholar
  11. 11.
    Risstad H, Søvik TT, et al. Five-year outcomes after laparoscopic gastric bypass and laparoscopic duodenal switch in patients with body mass index of 50 to 60: a randomized clinical trial. JAMA Surg. 2015;150:352–61.CrossRefPubMedGoogle Scholar
  12. 12.
    Nett P, Borbély Y, Kröll D. Micronutrient supplementation after biliopancreatic diversion with duodenal switch in the long term. Obes Surg. 2016.Google Scholar
  13. 13.
    Hewitt S, Søvik TT, et al. Secondary hyperparathyroidism, vitamin D sufficiency, and serum calcium 5 years after gastric bypass and duodenal switch. Obes Surg. 2013;23:384–90.CrossRefPubMedGoogle Scholar
  14. 14.
    Hamoui N, Kim K, Anthone G, et al. The significance of elevated levels of parathyroid hormone in patients with morbid obesity before and after bariatric surgery. Arch Surg. 2003;138:891–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Homan J, Betzel B, Aarts EO, et al. Vitamin and mineral deficiencies after biliopancreatic diversion and biliopancreatic diversion with duodenal switch—the rule rather than the exception. Obes Surg. 2015;25:1626–32.CrossRefPubMedGoogle Scholar
  16. 16.
    Sinha N, Shieh A, Stein EM, et al. Increased PTH and 1.25(OH)(2)D levels associated with increased markers of bone turnover following bariatric surgery. Obesity (Silver Spring). 2011;19:2388–93.CrossRefGoogle Scholar
  17. 17.
    Sallé A, Demarsy D, Poirier AL, et al. Zinc deficiency: a frequent and underestimated complication after bariatric surgery. Obes Surg. 2010;20:1660–70.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Philippe Topart
    • 1
  • Guillaume Becouarn
    • 1
  • Jacques Delarue
    • 2
  1. 1.Société de Chirurgie ViscéraleClinique de l’AnjouAngersFrance
  2. 2.Department of Nutritional Sciences & Laboratory of Human Nutrition, Breton Federation of Food and Human Nutrition (FED4216)University HospitalBrestFrance

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